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Desensitization strategies: is it worth it?

Sarat Kuppachi1, David A Axelrod2

  • 1Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.

Transplant International : Official Journal of the European Society for Organ Transplantation
|September 26, 2019
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Summary

Highly sensitized kidney transplant patients can undergo desensitization therapy to remove donor-specific antibodies (DSAs), enabling successful transplantation. This approach offers improved survival and cost-effectiveness compared to long-term dialysis.

Keywords:
desensitizationdonor-specific antibodyeconomic analysiskidney transplant

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Area of Science:

  • Nephrology
  • Immunology
  • Transplantation

Background:

  • Preformed donor-specific antibodies (DSAs) pose a significant barrier to kidney transplantation.
  • Thousands of renal transplant candidates face limited options due to sensitization.
  • Kidney paired donation is effective for living donor recipients, but alternative strategies are needed for highly sensitized patients.

Purpose of the Study:

  • To evaluate the efficacy and cost-effectiveness of desensitization protocols for kidney transplant recipients with preformed DSAs.
  • To assess the viability of transplantation for highly sensitized patients lacking compatible donors or living donors.

Main Methods:

  • Desensitization involved removing DSAs using plasmapheresis, intravenous immunoglobulin, and anti-CD20 antibodies.
  • Patients underwent transplantation following successful desensitization.
  • Clinical outcomes and costs were compared to compatible transplants and long-term dialysis.

Main Results:

  • Desensitization protocols enabled successful kidney transplantation in highly sensitized patients.
  • While clinical outcomes were inferior to compatible transplants, they offered improved survival compared to long-term dialysis.
  • The strategies were found to be cost-effective based on national benchmarks.

Conclusions:

  • Desensitization is a viable strategy for kidney transplant candidates with preformed DSAs, especially those who are highly sensitized or lack living donors.
  • Despite higher initial costs and less optimal outcomes than compatible transplants, desensitization provides a life-improving alternative to dialysis.
  • This approach enhances survival and demonstrates cost-effectiveness in the context of end-stage renal disease management.