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Kidney Transplantation in Sensitized Recipients; A Single Center Experience

A successful transplantation, across a positive crossmatch barrier, is one of the most persistent long-standing problems in the field of kidney transplant medicine. The aim of this study was to describe seven consecutive living renal transplantations in recipients with positive crossmatch for donors...

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Autores principales: Kim, Sun Moon, Lee, Chungsik, Lee, Jung Pyo, Kim, Eun Man, Ha, Jongwon, Kim, Sang Joon, Park, Myoung Hee, Ahn, Curie, Kim, Yon Su
Formato: Texto
Lenguaje:English
Publicado: The Korean Academy of Medical Sciences 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633205/
https://www.ncbi.nlm.nih.gov/pubmed/19194544
http://dx.doi.org/10.3346/jkms.2009.24.S1.S143
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author Kim, Sun Moon
Lee, Chungsik
Lee, Jung Pyo
Kim, Eun Man
Ha, Jongwon
Kim, Sang Joon
Park, Myoung Hee
Ahn, Curie
Kim, Yon Su
author_facet Kim, Sun Moon
Lee, Chungsik
Lee, Jung Pyo
Kim, Eun Man
Ha, Jongwon
Kim, Sang Joon
Park, Myoung Hee
Ahn, Curie
Kim, Yon Su
author_sort Kim, Sun Moon
collection PubMed
description A successful transplantation, across a positive crossmatch barrier, is one of the most persistent long-standing problems in the field of kidney transplant medicine. The aim of this study was to describe seven consecutive living renal transplantations in recipients with positive crossmatch for donors or positive for donor specific antibodies (DSAs). A preconditioning regimen including plasmapheresis and intravenous immunoglobulin was delivered three times a week until the crossmatch and/or DSAs became negative. Mycophenolate mofetil and tacrolimus were started two days before the plasmapheresis. The protocol was modified to include administration of anti-CD 20 antibody (rituximab, 375 mg/m(2)) from the patient number 3 through the patient number 7. All seven patients achieved negative conversion of the crossmatch or DSAs, and the kidney transplantations were successfully performed in all cases. Acute cellular rejection occurred in two patients, which were subclinical and controlled with high dose steroid treatment. Antibody-mediated rejection occurred in one patient, which was easily reversed with plasmapheresis. All recipients attained normal graft function during the 7-24 months of follow up. Our study suggests that sensitized patients can be transplanted successfully with desensitization pretreatment.
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spelling pubmed-26332052009-02-03 Kidney Transplantation in Sensitized Recipients; A Single Center Experience Kim, Sun Moon Lee, Chungsik Lee, Jung Pyo Kim, Eun Man Ha, Jongwon Kim, Sang Joon Park, Myoung Hee Ahn, Curie Kim, Yon Su J Korean Med Sci Original Article A successful transplantation, across a positive crossmatch barrier, is one of the most persistent long-standing problems in the field of kidney transplant medicine. The aim of this study was to describe seven consecutive living renal transplantations in recipients with positive crossmatch for donors or positive for donor specific antibodies (DSAs). A preconditioning regimen including plasmapheresis and intravenous immunoglobulin was delivered three times a week until the crossmatch and/or DSAs became negative. Mycophenolate mofetil and tacrolimus were started two days before the plasmapheresis. The protocol was modified to include administration of anti-CD 20 antibody (rituximab, 375 mg/m(2)) from the patient number 3 through the patient number 7. All seven patients achieved negative conversion of the crossmatch or DSAs, and the kidney transplantations were successfully performed in all cases. Acute cellular rejection occurred in two patients, which were subclinical and controlled with high dose steroid treatment. Antibody-mediated rejection occurred in one patient, which was easily reversed with plasmapheresis. All recipients attained normal graft function during the 7-24 months of follow up. Our study suggests that sensitized patients can be transplanted successfully with desensitization pretreatment. The Korean Academy of Medical Sciences 2009-01 2009-01-28 /pmc/articles/PMC2633205/ /pubmed/19194544 http://dx.doi.org/10.3346/jkms.2009.24.S1.S143 Text en Copyright © 2009 The Korean Academy of Medical Sciences http://creativecommons.org/licenses/by-nc/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Kim, Sun Moon
Lee, Chungsik
Lee, Jung Pyo
Kim, Eun Man
Ha, Jongwon
Kim, Sang Joon
Park, Myoung Hee
Ahn, Curie
Kim, Yon Su
Kidney Transplantation in Sensitized Recipients; A Single Center Experience
title Kidney Transplantation in Sensitized Recipients; A Single Center Experience
title_full Kidney Transplantation in Sensitized Recipients; A Single Center Experience
title_fullStr Kidney Transplantation in Sensitized Recipients; A Single Center Experience
title_full_unstemmed Kidney Transplantation in Sensitized Recipients; A Single Center Experience
title_short Kidney Transplantation in Sensitized Recipients; A Single Center Experience
title_sort kidney transplantation in sensitized recipients; a single center experience
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633205/
https://www.ncbi.nlm.nih.gov/pubmed/19194544
http://dx.doi.org/10.3346/jkms.2009.24.S1.S143
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