Long-term Outcomes of Kidney Transplantation in Patients With High Levels of Preformed DSA: The Necker High-Risk Transplant Program. Issue 10 (October 2017)

• Record Type: Journal Article
• Authors: Amrouche, Lucile; Aubert, Olivier; Suberbielle, Caroline; Rabant, Marion; Van Huyen, Jean-Paul Duong; Martinez, Frank; Sberro-Soussan, Rebecca; Scemla, Anne; Tinel, Claire; Snanoudj, Renaud; Zuber, Julien; Cavalcanti, Ruy; Timsit, Marc-Olivier; Lamhaut, Lionel; Anglicheau, Dany; Loupy, Alexandre; Legendre, Christophe
• Is Part Of: Transplantation. Volume 101:Issue 10(2017)
• Publication Date: 2017-10
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000001650
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: There is an increasing number of anti-HLA sensitized and highly sensitized renal transplant candidates on waiting lists, and the presence of donor-specific alloantibodies (DSAs) at the time of transplantation leads to acute and chronic antibody-mediated rejection (AMR). Acceptable short-term outcomes have been described, notably because of desensitization protocols, but mid- and long-term data are still required. Methods: Our high immunologic risk program included 95 patients with high peak or day 0 DSA levels (mean fluorescence intensity [MFI] > 3000) with a complement-dependent cytotoxicity-negative crossmatch, who received a posttransplant desensitization protocol starting at day 0 with high-dose intravenous immunoglobulin, plasma exchanges, and eventually rituximab. Their characteristics were compared with a control group including 39 patients with a lower immunologic risk (MFI between 500 and 3000 at day 0) who received the same posttransplant desensitization. Results: The median MFI of the immunodominant class I or II DSA in the peak or day 0 serum was 9421 (interquartile range, 4959-12 610). An AMR occurred during the first posttransplant year in 31 patients (32.6%), and at one year, the rate of chronic AMR was 39.5%. The 1-, 3-, 5- and 7-year death-censored allograft survival rates were 98%, 91%, 86%, and 78%, respectively, with concomitant recipient survival rates of 97%, 93%, 85%, and 79%, respectively. Conclusions: These results suggest that DSA-sensitized patients with high MFI levels can receive transplantation across the HLA-barrier, with the use of an intensified posttransplant immunosuppressive therapy starting at day 0 combined with close clinical, immunologic, and histologic monitoring. Abstract : Even DSA-positive renal transplant recipients with high MFI levels can achieve good long-term outcome by a posttransplant intensive desensitization protocol starting at day-0 with high-dose IVIg, plasma exchanges, and rituximab injection combined with posttransplant clinical and immunologic close monitoring. Supplemental digital content is available in the text.