Kidney transplantation after desensitization in sensitized patients

A Korean National Audit

Kyu Ha Huh, Beom Seok Kim, Jaeseok Yang, Jeongmyung Ahn, Myung-Gyu Kim, Jae Berm Park, Jong Man Kim, Byung Ha Chung, Joong Kyung Kim, Jin Min Kong

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Introduction The number of end-stage renal disease (ESRD) patients with preformed antibodies waiting for a kidney transplant has been increasing lately. We conducted a nationwide study on the outcomes of kidney transplantation after desensitization in Korea. Methods: Six transplant centers have run desensitization programs. The patients who underwent living donor kidney transplantation after desensitization from 2002 to 2010 were retrospectively analyzed. Results: A total of 86 cases were enrolled. Thirty-five of these were cases of re-transplantation (40.7 %). Indications of desensitization were positive complement-dependent cytotoxicity (CDC) cross-match responses (CDC +, 36.0 %), positive flow-cytometric cross-match responses (FCX?, 54.7 %), and positive donor-specific antibodies (DSA?, 8.1 %). The desensitization protocols used pre-transplant plasmapheresis (95.3 %), intravenous immunoglobulin (62.8 %), and rituximab (67.4 %). Acute rejection occurred in 18 patients (20.9 %), graft failure occurred in 4 patients, and the 3-year graft survival rate was 93.8 %. The presence of DSA increased the acute rejection rate (P = 0.015) and decreased the 1-year post-transplant estimated glomerular filtration rate (P = 0.006). Although rejection-free survival rates did not differ significantly between the CDC+ and FCX? groups, the 1-year estimated glomerular filtration rate was lower in the CDC+ group (P = 0.010). Infectious and significant bleeding complications occurred in 15.5 % and 4.7 % of cases, respectively. Conclusion: Kidney transplantation after desensitization had good graft outcomes and tolerable complications in Korea, and therefore, this therapy can be recommended for sensitized ESRD patients.

Original languageEnglish
Pages (from-to)1549-1557
Number of pages9
JournalInternational Urology and Nephrology
Volume44
Issue number5
DOIs
Publication statusPublished - 2012 Oct 1
Externally publishedYes

Fingerprint

Kidney Transplantation
Transplants
Korea
Glomerular Filtration Rate
Chronic Kidney Failure
Survival Rate
Plasmapheresis
Antibodies
Living Donors
Intravenous Immunoglobulins
Graft Survival
Transplantation
Outcome Assessment (Health Care)
Tissue Donors
Hemorrhage
Kidney

Keywords

  • Immunologic desensitization
  • Kidney transplantation
  • Rejection

ASJC Scopus subject areas

  • Nephrology
  • Urology

Cite this

Kidney transplantation after desensitization in sensitized patients : A Korean National Audit. / Huh, Kyu Ha; Kim, Beom Seok; Yang, Jaeseok; Ahn, Jeongmyung; Kim, Myung-Gyu; Park, Jae Berm; Kim, Jong Man; Chung, Byung Ha; Kim, Joong Kyung; Kong, Jin Min.

In: International Urology and Nephrology, Vol. 44, No. 5, 01.10.2012, p. 1549-1557.

Research output: Contribution to journalArticle

Huh, KH, Kim, BS, Yang, J, Ahn, J, Kim, M-G, Park, JB, Kim, JM, Chung, BH, Kim, JK & Kong, JM 2012, 'Kidney transplantation after desensitization in sensitized patients: A Korean National Audit', International Urology and Nephrology, vol. 44, no. 5, pp. 1549-1557. https://doi.org/10.1007/s11255-012-0169-1
Huh, Kyu Ha ; Kim, Beom Seok ; Yang, Jaeseok ; Ahn, Jeongmyung ; Kim, Myung-Gyu ; Park, Jae Berm ; Kim, Jong Man ; Chung, Byung Ha ; Kim, Joong Kyung ; Kong, Jin Min. / Kidney transplantation after desensitization in sensitized patients : A Korean National Audit. In: International Urology and Nephrology. 2012 ; Vol. 44, No. 5. pp. 1549-1557.
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AU - Yang, Jaeseok

AU - Ahn, Jeongmyung

AU - Kim, Myung-Gyu

AU - Park, Jae Berm

AU - Kim, Jong Man

AU - Chung, Byung Ha

AU - Kim, Joong Kyung

AU - Kong, Jin Min

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N2 - Introduction The number of end-stage renal disease (ESRD) patients with preformed antibodies waiting for a kidney transplant has been increasing lately. We conducted a nationwide study on the outcomes of kidney transplantation after desensitization in Korea. Methods: Six transplant centers have run desensitization programs. The patients who underwent living donor kidney transplantation after desensitization from 2002 to 2010 were retrospectively analyzed. Results: A total of 86 cases were enrolled. Thirty-five of these were cases of re-transplantation (40.7 %). Indications of desensitization were positive complement-dependent cytotoxicity (CDC) cross-match responses (CDC +, 36.0 %), positive flow-cytometric cross-match responses (FCX?, 54.7 %), and positive donor-specific antibodies (DSA?, 8.1 %). The desensitization protocols used pre-transplant plasmapheresis (95.3 %), intravenous immunoglobulin (62.8 %), and rituximab (67.4 %). Acute rejection occurred in 18 patients (20.9 %), graft failure occurred in 4 patients, and the 3-year graft survival rate was 93.8 %. The presence of DSA increased the acute rejection rate (P = 0.015) and decreased the 1-year post-transplant estimated glomerular filtration rate (P = 0.006). Although rejection-free survival rates did not differ significantly between the CDC+ and FCX? groups, the 1-year estimated glomerular filtration rate was lower in the CDC+ group (P = 0.010). Infectious and significant bleeding complications occurred in 15.5 % and 4.7 % of cases, respectively. Conclusion: Kidney transplantation after desensitization had good graft outcomes and tolerable complications in Korea, and therefore, this therapy can be recommended for sensitized ESRD patients.

AB - Introduction The number of end-stage renal disease (ESRD) patients with preformed antibodies waiting for a kidney transplant has been increasing lately. We conducted a nationwide study on the outcomes of kidney transplantation after desensitization in Korea. Methods: Six transplant centers have run desensitization programs. The patients who underwent living donor kidney transplantation after desensitization from 2002 to 2010 were retrospectively analyzed. Results: A total of 86 cases were enrolled. Thirty-five of these were cases of re-transplantation (40.7 %). Indications of desensitization were positive complement-dependent cytotoxicity (CDC) cross-match responses (CDC +, 36.0 %), positive flow-cytometric cross-match responses (FCX?, 54.7 %), and positive donor-specific antibodies (DSA?, 8.1 %). The desensitization protocols used pre-transplant plasmapheresis (95.3 %), intravenous immunoglobulin (62.8 %), and rituximab (67.4 %). Acute rejection occurred in 18 patients (20.9 %), graft failure occurred in 4 patients, and the 3-year graft survival rate was 93.8 %. The presence of DSA increased the acute rejection rate (P = 0.015) and decreased the 1-year post-transplant estimated glomerular filtration rate (P = 0.006). Although rejection-free survival rates did not differ significantly between the CDC+ and FCX? groups, the 1-year estimated glomerular filtration rate was lower in the CDC+ group (P = 0.010). Infectious and significant bleeding complications occurred in 15.5 % and 4.7 % of cases, respectively. Conclusion: Kidney transplantation after desensitization had good graft outcomes and tolerable complications in Korea, and therefore, this therapy can be recommended for sensitized ESRD patients.

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