August 14, 2011

Desensitization in HLA-Incompatible Kidney Recipients and Survival


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Sensitization to HLA antigens results in increased waiting times for a transplant, which is associated with an increased risk of death. The current study examined whether performing living-donor renal transplants following desensitization resulted in a survival benefit when compared to equally sensitized patients on the wait list. A protocol using plasmapheresis and low-dose IVIg was used to desensitize 211 patients. Desensitization treatments increased according to the levels of donor-specific antibodies at the time of transplant. Although patient survival rates were no different in the first year, the desensitization group showed improved patient survival compared to dialysis-only at the three year mark, and at eight years a clear advantage was seen with a 78% patient survival in the desensitization group compared to 27% in the dialysis-only group. However, despite the clear advantage over dialysis-only, the rates of death in the desensitization group were higher than expected given that these were living donor transplants. Despite that, the study shows a survival benefit for sensitized patients who have a willing but incompatible kidney donor.

 

Renal Transplantation

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