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Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach
Published on: May 7, 2019
Kidney transplantation in immunologically high-risk patients
K Keven1, S Sengul, Z K Celebi
1Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey.
Transplantation Proceedings
|April 30, 2013
Summary
Kidney transplantation (KTx) is feasible in sensitized patients with donor-specific antibodies (DSA) using novel immunosuppression. While successful, this approach carries a higher risk of acute rejection, necessitating further research on optimal desensitization protocols.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Kidney transplantation (KTx) is limited by donor-specific antibodies (DSA) in sensitized patients, increasing mortality and morbidity.
- Novel immunosuppressive protocols show promise for successful KTx in DSA-positive individuals.
Purpose of the Study:
- To evaluate the efficacy and outcomes of a desensitization protocol for living donor kidney transplantation in DSA-positive patients.
Main Methods:
- Five DSA-positive, lymphocyte cross-match negative patients received a multi-drug immunosuppression regimen including mycophenolate mofetil, tacrolimus, prednisolone, total plasma exchange (TPE), IVIG, rituximab, and basiliximab.
- Serum DSA levels (MFI) were monitored pre- and post-transplantation.
Main Results:
- All patients achieved immediate graft function with significant reduction in DSA MFI from a mean of 5624 to 2753 at transplantation, 2564 at 1 month, and 802 at 1 year.
- Sixty percent (3/5) of patients experienced acute rejection episodes, which were treated successfully.
- Average follow-up was 17 months with final creatinine levels between 0.6-0.8 mg/dL.
Conclusions:
- Living donor kidney transplantation is achievable in sensitized patients with DSA using intensive immunosuppression and desensitization.
- A higher risk of acute rejection is observed, highlighting the need for optimized desensitization protocols and further investigation into safe DSA MFI thresholds.
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