Highly HLA Sensitized Kidney Transplant Patients in a Transplant Center

Approximately 10% to 30% of patients on renal transplant waiting lists are sensitized, which gives them more time on the waiting list. Transplantation in this setting has a greater risk of rejection and decreased graft survival. New strategies of donor allocation through virtual crossmatching and optimization of immunosuppressive therapies in induction and maintenance have allowed the allocation of organs for this population, which in other circumstances would not be chosen for a kidney transplant.

To describe the experience of renal transplantation in highly sensitized patients with a panel reactive antibody of >80% in a transplant center, through virtual crossmatching, discarding unacceptable antigens, and without desensitization treatment.

An observational, descriptive, retrospective case series study was conducted on highly sensitized kidney transplant patients with a panel reactive antibody of ≥80% from 2010 to 2016.

A total of 10 highly sensitized transplant patients were identified. Six patients were women, all of whom had a history of pregnancy; all patients had undergone blood transfusions, and 40% had undergone a first transplant. Average time spent on dialysis was 148.5 months, and on the waiting list, 45.8 months. Average follow-up was 42 months (range, 10-84 months). The estimated glomerular filtration rate by the Chronic Kidney Disease Epidemiology Collaboration method at year 1 was 75 mL/min/1.73 m² body surface. Nine patients at 1 year posttransplantation had graft and patient survivals of 100%, as did 5 patients at >3 years posttransplantation.

Renal transplantation based on virtual crossmatching is a good alternative for highly sensitized patients.