Repository for Antibody Incompatible Transplantation Evidence

A case of successful desensitization using therapeutic plasma exchange in high-risk HLA incompatible kidney transplantation.

Transpl Immunol. 2022 Oct;74:101656 doi: 10.1016/j.trim.2022.101656.
Abstract

Advances in immune suppression therapies and desensitization have made possible kidney transplantation regardless of HLA incompatibility. Single antigen bead assay (SAB) is a semi-quantitative estimation of the amount of human leukocyte antigen (HLA) antibodies present in the recipient plasma, and mean fluorescence intensity (MFI) generated gives this rough estimation of the antibodies present in the recipient. Here we present a case of successful kidney transplantation in a patient who expressed DSA with high MFI. A 33-yr-old male, diagnosed with chronic kidney disease (CKD) on regular maintenance hemodialysis, opted for second kidney transplant with his sibling as prospective donor and was referred to the department of Transplant Immunology for histocompatibility testing. Patient had HLA incompatibility with multiple DSA identified by SAB. Patient undergone 20 sessions of plasma exchange till discharge and finally till 6 months graft was functioning well. The authors thus conclude that the option of a high-risk HLA incompatible kidney transplant can be offered to recipients with high MFI DSA, who wish to undergo transplantation for end stage renal disease.

Metadata
LEVEL OF EVIDENCE: Case Report
LANGUAGE: English
ORGAN TYPE: Kidney
KEYWORDS: Desensitization transplant; HLA incompatible kidney transplant; Kidney transplant
MESH HEADINGS: Graft Rejection / therapy; Graft Survival; HLA Antigens; Histocompatibility Testing; Humans; Kidney Transplantation*; Male; Plasma Exchange; Retrospective Studies