Related Experiment Video
Updated: May 16, 2026
Murine Renal Transplantation Procedure
Published on: July 10, 2009
Pediatric renal transplantation in a highly sensitised child-8 years on
Catherine Quinlan1, Atif Awan, Denis Gill
1Paediatric Renal Transplant Centre, The Children's University Hospital, Temple Street, Dublin 1, Ireland.
Insights
Highly sensitized children face challenges with deceased donor kidney transplants. A novel sequential desensitization protocol enabled a successful transplant, with the graft functioning well for 8 years.
Area of Science:
- Pediatric Nephrology
- Transplant Immunology
- Immunosuppression Therapy
Background:
- Highly sensitized children have poor outcomes with deceased donor renal transplants.
- Limited long-term follow-up data exists for desensitized pediatric transplant recipients.
Observation:
- A highly sensitized pediatric patient with a history of two failed transplants presented with donor-specific HLA Class I antibodies.
- Despite a positive T and B cell flow crossmatch, a deceased donor kidney transplant was performed.
Findings:
- A sequential desensitization protocol utilizing rituximab, intravenous immunoglobulin (IVIg), and plasma exchange was employed.
- The patient received a kidney from a donor with HLA antigens to which she had pre-existing antibodies.
- The renal graft has shown sustained function for 8 years post-transplantation.
Implications:
- This case demonstrates the potential efficacy of a multi-agent desensitization protocol in highly sensitized pediatric patients.
- Successful transplantation in highly sensitized children can lead to long-term graft survival.
- The findings support the consideration of desensitization protocols for pediatric patients with high levels of sensitization.
Abstract:
Highly sensitised children have markedly reduced chances of receiving a successful deceased donor renal transplant, increased risk of rejection, and decreased graft survival. There is limited experience with the long-term followup of children who have undergone desensitization. Following 2 failed transplants, our patient was highly sensitised. She had some immunological response to intravenous immunoglobulin (IVIg) but this was not sustained. We developed a protocol involving sequential therapies with rituximab, IVIg, and plasma exchange. Immunosuppressant therapy at transplantation consisted of basiliximab, tacrolimus, mycophenolate mofetil, and steroids. At the time of transplantation, historical crossmatch was ignored. Current CDC crossmatch was negative, but T and B cell flow crossmatch was positive, due to donor-specific HLA Class I antibodies. Further plasma exchange and immunoglobulin therapy were given pre- and postoperatively. Our patient received a deceased donor-kidney-bearing HLA antigens to which she originally had antibodies, which would have precluded transplant. The graft kidney continues to function well 8 years posttransplant.
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