Nephrology – Original Paper

International Urology and Nephrology

, Volume 44, Issue 5, pp 1549-1557

First online:

Kidney transplantation after desensitization in sensitized patients: a Korean National Audit

  • Kyu Ha HuhAffiliated withDepartment of Surgery, Yonsei University College of Medicine
  • , Beom Seok KimAffiliated withDepartment of Internal Medicine, Yonsei University College of Medicine
  • , Jaeseok YangAffiliated withTransplantation Center, Seoul National University HospitalTransplantation Research Institute, Seoul National University College of Medicine Email author 
  • , Jeongmyung AhnAffiliated withDepartment of Internal Medicine, Maryknoll Medical Center
  • , Myung-Gyu KimAffiliated withTransplantation Center, Seoul National University Hospital
  • , Jae Berm ParkAffiliated withDepartment of Surgery, University of Ulsan College of Medicine
  • , Jong Man KimAffiliated withDepartment of Surgery, Sungkyunkwan University School of Medicine
  • , Byung-Ha ChungAffiliated withDepartment of Internal Medicine, The Catholic University of Korea
  • , Joong Kyung KimAffiliated withDepartment of Medicine, Bong Seng Hospital
    • , Jin Min KongAffiliated withDepartment of Internal Medicine, Maryknoll Medical Center

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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.

Keywords

Immunologic desensitization Kidney transplantation Rejection