Management of Highly Sensitized Patients in Renal Transplantation: Prospective Single-Center Study
DOI:
https://doi.org/10.56056/415Keywords:
Allograft, Cross-sectional study, Donor Specific Antigen Screening, Renal TransplantationAbstract
Background and objectives: In kidney transplantation, immunologic risk assessment was performed through pretransplant measurement of human leukocyte antigen, donor-specific antibodies. The aim of this study was to address the impact of early pre-transplant donor-specific antibodies screening.
Methods: A cross-sectional study was conducted in the Duhok Kidney Center in the Kurdistan region, Iraq. The study started on the 1st of March 2021 till the 1st of July 2023. A convenient nonrandom sampling of 40 pairs of patients and donors was included in this study. a structural close-ended questionnaire prepared. The first part of the questionnaire included the socio demographic characteristics of the studied sample. The age, gender, occupation, and residency of both the recipient and the donor were recorded. The induction immunosuppression and type of transplants were investigated.
Results: Most recipients (70%) were weakly sensitized; the moderate group rated 22.5%, and the strong group rated 7.5%. The mean age of the recipients was 40.02 ± 9.33, and they were followed for 2.05 ±0.84 years. The mean of donor-specific antibodies was compared before and after induction therapy: 4454.02±3227.10 vs 1479.85±1044.12, respectively. The result was highly significant. The history of the previous renal transplants was 17.5%, the blood transfusion was 5%, and the history of pregnancy was 57.5%. The mean difference in glomerular filtration rate was 8 ± 2.6 vs. 81.24 ± 24.06 among the rejected and non-rejected groups. The serum creatine was 6.7 ± 1.01 in the rejected and 1.14 ±1.17 in the non-rejected group.
Conclusion: Multiple plasmapheresis sessions were part of the desensitization protocol, with low-dose immunoglobulin and Rituximab administered simultaneously. Based on these findings, in the future, we anticipate that safe kidney transplantation will be performed even in highly sensitized recipients, thereby actively improving their prognosis.
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