Platelet based regimen in desensitization of highly sensitized patients with kidney transplantation. A novel therapy

Kidney transplantation remains the best treatment for patients with renal failure. Some patients, however, have high levels of anti-human leukocyte antigen (anti-HLA) antibodies so transplantation is not possible for them. To address this, we used desensitization, where plasmapheresis and intravenous immunoglobulin replaced with a new platelet-based approach to lower costs and reduce complications. We then assessed graft survival after transplantation.

In this historical cohort study, we enrolled 48 patients with calculated panel of reactive antibodies (cPRA) levels greater than 90% who were eligible for desensitization between 2018 and 2024. All patients received a desensitization regimen consisting of bortezomib, rituximab, and platelets, followed by kidney transplantation. Post-transplant, all patients were monitored for graft and patient survival.

Among the 48 transplanted patients, only three (6.3%) experienced acute rejection during the six-year follow-up period. The six-year censored graft and patient survival were 98% and 97% calculated using the life-table method. Patient survival for one and six years was 97% and 68%, respectively.

The study demonstrated that a desensitization regimen combining rituximab, bortezomib and platelets effectively reduced cPRA in highly sensitized patients, thereby enhancing their eligibility for transplantation. Additionally, this approach is associated with a significant reduction in rejection rates compared to conventional desensitization regimens, highlighting its advantages in improving transplant outcomes.