Renal Transplantation in Donor Specific Antibody Positive Sensitized Patients: Single Center Experience

In recent years, there are increasing number of sensitized patients waiting for renal transplantation (RTx) who are donor specific antibody (DSA) positive and lymphocyte crossmatch (LCM) negative. In this study, we present our transplantation experience in patients with LCM (-) and DSA (+). We enrolled 4 LCM (-) and panel reactive antibody (PRA) screening positive patients who had a living kidney donor. We evaluated antibodies to determine whether they were DSA or not. If they were DSA, we included these patients in our protocol (DSA level: mean fluorescein intensity > 1000). Two had previous RTx. In our protocol, we started MMF (2gr/day), tacrolimus 0.01 mg/kg, and prednisolone 0.5 mg/kg on day -6. We performed 2 sessions of plasmapheresis (PP) and gave 2 doses of 5 gr/day IVIG. On day -1, 200 mg rituximab was given. On the operation day, the patients received basiliximab. Serum samples were taken on days -6, 0, and 30. All patients had immediate graft function after RTx. Two patients had acute rejection (AR). Average follow up was 4 months and creatinine levels are 0.7-1.3 mg/dl. In conclusion, RTx can be succesfully performed in sensitized patients with DSA. However, there seems to be higher acute rejection risk in these patients.