Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy
Summary Living donor kidney transplantation in crossmatch‐positive patients is a challenge that requires specific measures. Ten patients with positive crossmatch results (n = 9) or negative crossmatch results but strong donor‐specific antibodies (DSA; n = 1) were desensitized using immunoadsorption...
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| Veröffentlicht in: | Transplant international 2012-05, Vol.25 (5), p.506-517 |
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| creator | Morath, Christian Beimler, Jörg Opelz, Gerhard Scherer, Sabine Schmidt, Jan Macher-Goeppinger, Stephan Klein, Katrin Sommerer, Claudia Schwenger, Vedat Zeier, Martin Süsal, Caner |
| description | Summary
Living donor kidney transplantation in crossmatch‐positive patients is a challenge that requires specific measures. Ten patients with positive crossmatch results (n = 9) or negative crossmatch results but strong donor‐specific antibodies (DSA; n = 1) were desensitized using immunoadsorption (IA) and anti‐CD20 antibody induction. IA was continued after transplantation and accompanied by HLA antibody monitoring and protocol biopsies. After a median of 10 IA treatments, all patients were desensitized successfully and transplanted. Median levels of mean fluorescence intensity (MFI) of Luminex‐DSA before desensitization were 6203 and decreased after desensitization and immediately before transplantation to 891. Patients received a median of seven post‐transplant IA treatments. At last visit, after a median follow‐up of 19 months, 9 of 10 patients had a functioning allograft and a median Luminex‐DSA of 149 MFI; serum creatinine was 1.6 mg/dl, and protein to creatinine ratio 0.1. Reversible acute antibody‐mediated rejection was diagnosed in three patients. One allograft was lost after the second post‐transplant year in a patient with catastrophic antiphospholipid syndrome. We describe a treatment algorithm for desensitization of living donor kidney transplant recipients that allows the rapid elimination of DSA with a low rate of side effects and results in good graft outcome. |
| doi_str_mv | 10.1111/j.1432-2277.2012.01447.x |
| format | Article |
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Living donor kidney transplantation in crossmatch‐positive patients is a challenge that requires specific measures. Ten patients with positive crossmatch results (n = 9) or negative crossmatch results but strong donor‐specific antibodies (DSA; n = 1) were desensitized using immunoadsorption (IA) and anti‐CD20 antibody induction. IA was continued after transplantation and accompanied by HLA antibody monitoring and protocol biopsies. After a median of 10 IA treatments, all patients were desensitized successfully and transplanted. Median levels of mean fluorescence intensity (MFI) of Luminex‐DSA before desensitization were 6203 and decreased after desensitization and immediately before transplantation to 891. Patients received a median of seven post‐transplant IA treatments. At last visit, after a median follow‐up of 19 months, 9 of 10 patients had a functioning allograft and a median Luminex‐DSA of 149 MFI; serum creatinine was 1.6 mg/dl, and protein to creatinine ratio 0.1. Reversible acute antibody‐mediated rejection was diagnosed in three patients. One allograft was lost after the second post‐transplant year in a patient with catastrophic antiphospholipid syndrome. We describe a treatment algorithm for desensitization of living donor kidney transplant recipients that allows the rapid elimination of DSA with a low rate of side effects and results in good graft outcome.</description><identifier>ISSN: 0934-0874</identifier><identifier>EISSN: 1432-2277</identifier><identifier>DOI: 10.1111/j.1432-2277.2012.01447.x</identifier><identifier>PMID: 22372718</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Algorithms ; Antibodies, Monoclonal, Murine-Derived - therapeutic use ; antibody-mediated rejection ; Blood Component Removal - methods ; Desensitization, Immunologic - methods ; Female ; Graft Rejection - diagnosis ; Graft Survival ; Histocompatibility Testing ; Humans ; immunoadsorption ; Immunosorbent Techniques ; Immunosuppression - methods ; kidney transplantation ; Kidney Transplantation - adverse effects ; Kidney Transplantation - immunology ; Kidney Transplantation - methods ; living donor ; Living Donors ; Male ; Middle Aged ; positive crossmatch ; Rituximab ; Transplants & implants ; Treatment Outcome</subject><ispartof>Transplant international, 2012-05, Vol.25 (5), p.506-517</ispartof><rights>2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation</rights><rights>2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3857-df1a6ed27403fe343ac6d68b3319303f3b0e7bd0ef54a9e165334472063250e63</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1432-2277.2012.01447.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1432-2277.2012.01447.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22372718$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Morath, Christian</creatorcontrib><creatorcontrib>Beimler, Jörg</creatorcontrib><creatorcontrib>Opelz, Gerhard</creatorcontrib><creatorcontrib>Scherer, Sabine</creatorcontrib><creatorcontrib>Schmidt, Jan</creatorcontrib><creatorcontrib>Macher-Goeppinger, Stephan</creatorcontrib><creatorcontrib>Klein, Katrin</creatorcontrib><creatorcontrib>Sommerer, Claudia</creatorcontrib><creatorcontrib>Schwenger, Vedat</creatorcontrib><creatorcontrib>Zeier, Martin</creatorcontrib><creatorcontrib>Süsal, Caner</creatorcontrib><title>Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy</title><title>Transplant international</title><addtitle>Transpl Int</addtitle><description>Summary
Living donor kidney transplantation in crossmatch‐positive patients is a challenge that requires specific measures. Ten patients with positive crossmatch results (n = 9) or negative crossmatch results but strong donor‐specific antibodies (DSA; n = 1) were desensitized using immunoadsorption (IA) and anti‐CD20 antibody induction. IA was continued after transplantation and accompanied by HLA antibody monitoring and protocol biopsies. After a median of 10 IA treatments, all patients were desensitized successfully and transplanted. Median levels of mean fluorescence intensity (MFI) of Luminex‐DSA before desensitization were 6203 and decreased after desensitization and immediately before transplantation to 891. Patients received a median of seven post‐transplant IA treatments. At last visit, after a median follow‐up of 19 months, 9 of 10 patients had a functioning allograft and a median Luminex‐DSA of 149 MFI; serum creatinine was 1.6 mg/dl, and protein to creatinine ratio 0.1. Reversible acute antibody‐mediated rejection was diagnosed in three patients. One allograft was lost after the second post‐transplant year in a patient with catastrophic antiphospholipid syndrome. We describe a treatment algorithm for desensitization of living donor kidney transplant recipients that allows the rapid elimination of DSA with a low rate of side effects and results in good graft outcome.</description><subject>Adult</subject><subject>Algorithms</subject><subject>Antibodies, Monoclonal, Murine-Derived - therapeutic use</subject><subject>antibody-mediated rejection</subject><subject>Blood Component Removal - methods</subject><subject>Desensitization, Immunologic - methods</subject><subject>Female</subject><subject>Graft Rejection - diagnosis</subject><subject>Graft Survival</subject><subject>Histocompatibility Testing</subject><subject>Humans</subject><subject>immunoadsorption</subject><subject>Immunosorbent Techniques</subject><subject>Immunosuppression - methods</subject><subject>kidney transplantation</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney Transplantation - immunology</subject><subject>Kidney Transplantation - methods</subject><subject>living donor</subject><subject>Living Donors</subject><subject>Male</subject><subject>Middle Aged</subject><subject>positive crossmatch</subject><subject>Rituximab</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><issn>0934-0874</issn><issn>1432-2277</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU9v1DAQxS0EokvhKyBLHDgl-E9iJwcOaFvaohVIaBFHy4lnqbeJE2ynbO58cJxuWSQsWR55fu9pNA8hTElO03m3z2nBWcaYlDkjlOWEFoXMD0_Q6tR4ilak5kVGKlmcoRch7AkhrCrJc3TGGJdM0mqFfm_svXU_sBnc4PGdNQ5mHL12Yey0izrawWHrcOuHEHod29tsHIKN9h7wmLrgYsDgdNOBwc2MR_D2nxzbvp_coE0Y_PhgpZ1JN9psfcEIjrfg9Ti_RM92ugvw6vE9R98-Xm7X19nmy9XN-sMma3lVyszsqBZgmCwI3wEvuG6FEVXDOa15-uINAdkYAruy0DVQUXKe1sKI4KwkIPg5env0Hf3wc4IQVW9DC10aFYYpqFpUlNQ15Yl88x-5Hybv0nCKSiGqOlGL3-tHamp6MGr0ttd-Vn_Xm4D3R-CX7WA-9SlRS4xqr5a01JKWWmJUDzGqg9p-vVmqpM-OehsiHE567e-UkFyW6vvnK3VRFVu-EZ_UNf8Dc2WhDA</recordid><startdate>201205</startdate><enddate>201205</enddate><creator>Morath, Christian</creator><creator>Beimler, Jörg</creator><creator>Opelz, Gerhard</creator><creator>Scherer, Sabine</creator><creator>Schmidt, Jan</creator><creator>Macher-Goeppinger, Stephan</creator><creator>Klein, Katrin</creator><creator>Sommerer, Claudia</creator><creator>Schwenger, Vedat</creator><creator>Zeier, Martin</creator><creator>Süsal, Caner</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QO</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201205</creationdate><title>Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy</title><author>Morath, Christian ; Beimler, Jörg ; Opelz, Gerhard ; Scherer, Sabine ; Schmidt, Jan ; Macher-Goeppinger, Stephan ; Klein, Katrin ; Sommerer, Claudia ; Schwenger, Vedat ; Zeier, Martin ; Süsal, Caner</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3857-df1a6ed27403fe343ac6d68b3319303f3b0e7bd0ef54a9e165334472063250e63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Algorithms</topic><topic>Antibodies, Monoclonal, Murine-Derived - therapeutic use</topic><topic>antibody-mediated rejection</topic><topic>Blood Component Removal - methods</topic><topic>Desensitization, Immunologic - methods</topic><topic>Female</topic><topic>Graft Rejection - diagnosis</topic><topic>Graft Survival</topic><topic>Histocompatibility Testing</topic><topic>Humans</topic><topic>immunoadsorption</topic><topic>Immunosorbent Techniques</topic><topic>Immunosuppression - methods</topic><topic>kidney transplantation</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Kidney Transplantation - immunology</topic><topic>Kidney Transplantation - methods</topic><topic>living donor</topic><topic>Living Donors</topic><topic>Male</topic><topic>Middle Aged</topic><topic>positive crossmatch</topic><topic>Rituximab</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Morath, Christian</creatorcontrib><creatorcontrib>Beimler, Jörg</creatorcontrib><creatorcontrib>Opelz, Gerhard</creatorcontrib><creatorcontrib>Scherer, Sabine</creatorcontrib><creatorcontrib>Schmidt, Jan</creatorcontrib><creatorcontrib>Macher-Goeppinger, Stephan</creatorcontrib><creatorcontrib>Klein, Katrin</creatorcontrib><creatorcontrib>Sommerer, Claudia</creatorcontrib><creatorcontrib>Schwenger, Vedat</creatorcontrib><creatorcontrib>Zeier, Martin</creatorcontrib><creatorcontrib>Süsal, Caner</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Transplant international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Morath, Christian</au><au>Beimler, Jörg</au><au>Opelz, Gerhard</au><au>Scherer, Sabine</au><au>Schmidt, Jan</au><au>Macher-Goeppinger, Stephan</au><au>Klein, Katrin</au><au>Sommerer, Claudia</au><au>Schwenger, Vedat</au><au>Zeier, Martin</au><au>Süsal, Caner</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy</atitle><jtitle>Transplant international</jtitle><addtitle>Transpl Int</addtitle><date>2012-05</date><risdate>2012</risdate><volume>25</volume><issue>5</issue><spage>506</spage><epage>517</epage><pages>506-517</pages><issn>0934-0874</issn><eissn>1432-2277</eissn><abstract>Summary
Living donor kidney transplantation in crossmatch‐positive patients is a challenge that requires specific measures. Ten patients with positive crossmatch results (n = 9) or negative crossmatch results but strong donor‐specific antibodies (DSA; n = 1) were desensitized using immunoadsorption (IA) and anti‐CD20 antibody induction. IA was continued after transplantation and accompanied by HLA antibody monitoring and protocol biopsies. After a median of 10 IA treatments, all patients were desensitized successfully and transplanted. Median levels of mean fluorescence intensity (MFI) of Luminex‐DSA before desensitization were 6203 and decreased after desensitization and immediately before transplantation to 891. Patients received a median of seven post‐transplant IA treatments. At last visit, after a median follow‐up of 19 months, 9 of 10 patients had a functioning allograft and a median Luminex‐DSA of 149 MFI; serum creatinine was 1.6 mg/dl, and protein to creatinine ratio 0.1. Reversible acute antibody‐mediated rejection was diagnosed in three patients. One allograft was lost after the second post‐transplant year in a patient with catastrophic antiphospholipid syndrome. We describe a treatment algorithm for desensitization of living donor kidney transplant recipients that allows the rapid elimination of DSA with a low rate of side effects and results in good graft outcome.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>22372718</pmid><doi>10.1111/j.1432-2277.2012.01447.x</doi><tpages>12</tpages></addata></record> |
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| ispartof | Transplant international, 2012-05, Vol.25 (5), p.506-517 |
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| subjects | Adult Algorithms Antibodies, Monoclonal, Murine-Derived - therapeutic use antibody-mediated rejection Blood Component Removal - methods Desensitization, Immunologic - methods Female Graft Rejection - diagnosis Graft Survival Histocompatibility Testing Humans immunoadsorption Immunosorbent Techniques Immunosuppression - methods kidney transplantation Kidney Transplantation - adverse effects Kidney Transplantation - immunology Kidney Transplantation - methods living donor Living Donors Male Middle Aged positive crossmatch Rituximab Transplants & implants Treatment Outcome |
| title | Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy |
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