Living donor kidney transplantation across positive crossmatch

The University of Illinois at Chicago Experience

James J. Thielke, Patricia M. West-Thielke, Heather L. Herren, Umberto Bareato, Thuy Ommert, Vladimir Vidanovic, Sally A. Campbell-Lee, Ivo G. Tzvetanov, Howard N. Sankary, Bruce Kaplan, Enrico Benedetti, Jose Oberholzer

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

BACKGROUND.: To increase living donation for kidney transplantation, we investigated desensitization of recipients with positive crossmatch against a potential living donor. METHODS.: Between June 2001 and March 2007, 57 consecutive sensitized candidates for kidney transplantation, with crossmatch positive potential living donors, were treated with various desensitization protocols. All patients received plasmapheresis every other day with intravenous immune globulin 100 mg/kg starting 1 week before the scheduled transplant. Postoperatively, the recipients continued to receive every other day plasmapheresis with intravenous immune globulin for the initial week. Immunosuppression therapy consisted of induction with thymoglobulin and a combination of tacrolimus, mycophenolate, and corticosteroids. RESULTS.: Six patients failed to convert with pretransplant immunomodulation and were not transplanted; 51 underwent live donor kidney transplant. Mean follow-up was 23 months and 36 patients have more than 1-year follow-up. One-year patient and graft survivals were 95% and 93%, respectively. There were 25 episodes of biopsy-proven or clinically presumed rejection in 22 patients in the first year. Of the 17 biopsy-proven episodes, 12 were antibody-mediated rejection and five were acute cellular rejection. Of the patients with antibody-mediated rejection (biopsy proven or empiric), two patients (12%) lost their graft by 1 year. The median modification of diet in renal disease at 6 and 12 months was 55 mL/min (range 9-104 mL/min) and 48 mL/min (range 8-99), respectively. CONCLUSIONS.: Despite increased rejection rates, graft and patient survivals indicate that desensitization of positive crossmatch patients is a reasonable alternative for a sensitized patient who could potentially wait 10 or more years for a suitable cadaveric kidney.

Original languageEnglish (US)
Pages (from-to)268-273
Number of pages6
JournalTransplantation
Volume87
Issue number2
DOIs
StatePublished - Jan 27 2009
Externally publishedYes

Fingerprint

Living Donors
Kidney Transplantation
Plasmapheresis
Intravenous Immunoglobulins
Graft Survival
Transplants
Kidney
Biopsy
Diet Therapy
Immunomodulation
Antibodies
Tacrolimus
Immunosuppression
Adrenal Cortex Hormones
Tissue Donors

Keywords

  • Acute rejection
  • Desensitization
  • Graft survival
  • Positive crossmatch

ASJC Scopus subject areas

  • Transplantation

Cite this

Thielke, J. J., West-Thielke, P. M., Herren, H. L., Bareato, U., Ommert, T., Vidanovic, V., ... Oberholzer, J. (2009). Living donor kidney transplantation across positive crossmatch: The University of Illinois at Chicago Experience. Transplantation, 87(2), 268-273. https://doi.org/10.1097/TP.0b013e3181919a16

Living donor kidney transplantation across positive crossmatch : The University of Illinois at Chicago Experience. / Thielke, James J.; West-Thielke, Patricia M.; Herren, Heather L.; Bareato, Umberto; Ommert, Thuy; Vidanovic, Vladimir; Campbell-Lee, Sally A.; Tzvetanov, Ivo G.; Sankary, Howard N.; Kaplan, Bruce; Benedetti, Enrico; Oberholzer, Jose.

In: Transplantation, Vol. 87, No. 2, 27.01.2009, p. 268-273.

Research output: Contribution to journalArticle

Thielke, JJ, West-Thielke, PM, Herren, HL, Bareato, U, Ommert, T, Vidanovic, V, Campbell-Lee, SA, Tzvetanov, IG, Sankary, HN, Kaplan, B, Benedetti, E & Oberholzer, J 2009, 'Living donor kidney transplantation across positive crossmatch: The University of Illinois at Chicago Experience', Transplantation, vol. 87, no. 2, pp. 268-273. https://doi.org/10.1097/TP.0b013e3181919a16
Thielke, James J. ; West-Thielke, Patricia M. ; Herren, Heather L. ; Bareato, Umberto ; Ommert, Thuy ; Vidanovic, Vladimir ; Campbell-Lee, Sally A. ; Tzvetanov, Ivo G. ; Sankary, Howard N. ; Kaplan, Bruce ; Benedetti, Enrico ; Oberholzer, Jose. / Living donor kidney transplantation across positive crossmatch : The University of Illinois at Chicago Experience. In: Transplantation. 2009 ; Vol. 87, No. 2. pp. 268-273.
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abstract = "BACKGROUND.: To increase living donation for kidney transplantation, we investigated desensitization of recipients with positive crossmatch against a potential living donor. METHODS.: Between June 2001 and March 2007, 57 consecutive sensitized candidates for kidney transplantation, with crossmatch positive potential living donors, were treated with various desensitization protocols. All patients received plasmapheresis every other day with intravenous immune globulin 100 mg/kg starting 1 week before the scheduled transplant. Postoperatively, the recipients continued to receive every other day plasmapheresis with intravenous immune globulin for the initial week. Immunosuppression therapy consisted of induction with thymoglobulin and a combination of tacrolimus, mycophenolate, and corticosteroids. RESULTS.: Six patients failed to convert with pretransplant immunomodulation and were not transplanted; 51 underwent live donor kidney transplant. Mean follow-up was 23 months and 36 patients have more than 1-year follow-up. One-year patient and graft survivals were 95{\%} and 93{\%}, respectively. There were 25 episodes of biopsy-proven or clinically presumed rejection in 22 patients in the first year. Of the 17 biopsy-proven episodes, 12 were antibody-mediated rejection and five were acute cellular rejection. Of the patients with antibody-mediated rejection (biopsy proven or empiric), two patients (12{\%}) lost their graft by 1 year. The median modification of diet in renal disease at 6 and 12 months was 55 mL/min (range 9-104 mL/min) and 48 mL/min (range 8-99), respectively. CONCLUSIONS.: Despite increased rejection rates, graft and patient survivals indicate that desensitization of positive crossmatch patients is a reasonable alternative for a sensitized patient who could potentially wait 10 or more years for a suitable cadaveric kidney.",
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