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The effect of desensitization therapy in kidney transplantation

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Abstract

Background

Desensitization therapy may enable the patient to get allograft in sensitized recipient or solve the organ shortage in ABO-incompatible relationship in kidney transplantation (KT). However, the graft outcome and morbidity remains unclear.

Methods

We retrospectively analyzed 845 KT patients from January 2010 to February 2016 at Seoul National University Hospital. The patients were divided into three groups as follows: HLA-incompatible (HLAi) group, ABO-incompatible (ABOi) group, and control group. The HLAi group comprised patients who received desensitization therapy due to the presence of donor-specific antibodies (DSAs) or high panel reactive antibodies (PRAs). The ABOi group is defined as those undergoing preoperative desensitization therapy for anti-ABO antibodies.

Results

Of the total of 845 recipients, 48 (5.6%) were HLAi KTs and 71 (13.9%) were ABOi KTs, respectively. Pre-emptive KT is done more frequently in ABOi group, therefore, they had shorter dialysis duration than the others. HLAi recipients had a higher proportion of women than the ABOi group and a higher proportion of re-transplantation. During the 38.4 (0.4–76.9) months of follow-up, there were more acute antibody-mediated rejections (AAMRs) in the HLAi (6.7%) and ABOi (8.5%) groups than in the control group (1.9%) (P = 0.001). However, there was no difference in graft survival, patient survival, and annual allograft among three groups.

Conclusions

Despite the higher incidence of AAMRs, HLAi and ABOi KTs showed a favorable graft and patient outcome after desensitization therapy.

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Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea

    Yong Chul Kim, Mi-yeon Yu & Hajeong Lee

  2. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea

    Jung Pyo Lee

  3. Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea

    Sang-Il Min & Jongwon Ha

  4. Department of Medical Science, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Yon Su Kim

  5. Kidney Research Institute, Seoul National University, Seoul, Republic of Korea

    Yon Su Kim

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  1. Yong Chul Kim
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  2. Mi-yeon Yu
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Correspondence to Yon Su Kim.

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Conflict of interest

The authors have no potential conflicts of interest to disclose.

Ethical approval

The present study was conducted with the approval of the Research Ethics Committee of the Seoul National University Hospital (Approval No.: H-1608-120-790). All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Kim, Y.C., Yu, My., Lee, J.P. et al. The effect of desensitization therapy in kidney transplantation. Clin Exp Nephrol 22, 179–187 (2018). https://doi.org/10.1007/s10157-017-1424-7

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  • DOI: https://doi.org/10.1007/s10157-017-1424-7

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