A high panel-reactive antibody rescue protocol for cross-match-positive live donor kidney transplants

Eugene J. Schweitzer, Jessica S. Wilson, Marcelo Fernandez-Vina, Michelle Fox, Martin Gutierrez, Anne Wiland, Jay Hunter, Alan Farney, Benjamin Philosophe, John Colonna, Bruce E. Jarrell, Stephen T. Bartlett

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Alloimmunization can present a virtually insurmountable barrier to kidney transplantation. Past protocols to desensitize patients using plasmapheresis and cyclophosphamide have not been broadly applied because of the fear of complications, including high rates of immunologic failure. Methods. Fifteen patients with a positive donor-recipient cross-match were desensitized with plasmapheresis to permit live donor (LD) transplantation under newer maintenance immunosuppressants. Pretransplant the patients received plasmapheresis three times weekly for a planned maximum of six treatments, plus intravenous hyperimmune globulin, tacrolimus, mycophenolate mofetil, and prednisone. Patients who were successfully desensitized and received transplants were given 10 days of OKT3 postoperatively. Results. Eleven of the 15 patients became anti-human globulin cross-match-negative after one to five plasmapheresis treatments and underwent LD transplantation. Relatively low initial titers of donor-specific antibody were predictive of successful attainment of a negative cross-match. Few side effects and rejection episodes were observed. All transplant patients remain dialysis-free after 3-26 months of follow-up. Conclusion. A positive cross-match is not necessarily a contraindication to LD transplantation, especially for patients with low donor-specific alloantibody titers.

Original languageEnglish (US)
Pages (from-to)1531-1536
Number of pages6
JournalTransplantation
Volume70
Issue number10
DOIs
StatePublished - Nov 27 2000
Externally publishedYes

ASJC Scopus subject areas

  • Transplantation

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