Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk, Gdańsk, Poland.
Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk, Gdańsk, Poland.
Transplant Proc. 2024 May;56(4):796-801. doi: 10.1016/j.transproceed.2024.04.015. Epub 2024 Apr 29.
The increasing number of highly immunized patients waiting for kidney transplantation is a significant problem in Europe as the proportion of such patients has doubled in the last decade. Transplantation in this group is enabled by desensitization methods, i.e., intravenous pharmacotherapy with human immunoglobulin (IVIG), anti-CD20 monoclonal antibody (rituximab), and plasma exchange. The objective was to evaluate the efficacy and safety of this protocol.
The inclusion criteria: presence of established anti-HLA antibodies with complement-binding capacity, i.e., anti-HLAC1q+ (>MFI 15,000 for the most common antigens), no renal transplantation within 1 year after activation on the waiting list. Thirteen patients were selected for the procedure. IVIG was administered twice (2 g/kg-maximum 140 g/dose). Between IVIG doses, patients received rituximab (375 mg/m). Anti-HLA was tested after 1 and 2 months after completion of the procedure.
All patients have completed the protocol. No significant changes after desensitization in the amount/profile of alloantibodies were observed. However, with negative vCM for HLA-A/B/DR (no DSA against the reported donor) and negative CM-CDC, according to the allocation system, patients were given priority on the recipient list. Seven out of 13 patients received a transplant within 12 months after treatment (mean 11.5 weeks). Renal graft function was good (mean creatinine level after 1 month: 1.5 mg/dL). No incidents of acute rejection were reported. The most common complications were infections (especially pneumonia).
The desensitization protocol (IVIG + rituximab) allows highly immunized patients to undergo organ transplantation. In short-term analysis, no acute rejection was observed, graft function was satisfactory. Desensitization was associated with an increased risk of infection.
在欧洲，越来越多的高度免疫患者等待肾移植是一个重大问题，因为此类患者的比例在过去十年中翻了一番。在该群体中进行移植是通过脱敏方法实现的，即静脉内用人免疫球蛋白（IVIG）、抗 CD20 单克隆抗体（利妥昔单抗）和血浆置换进行的。目的是评估该方案的疗效和安全性。
纳入标准：存在具有补体结合能力的已建立的抗 HLA 抗体，即抗 HLA-C1q+（最常见抗原的 MFI>15,000），在激活等待名单后 1 年内未进行肾移植。选择 13 名患者进行该程序。给予两次 IVIG（2 g/kg-最大剂量 140 g/剂量）。在 IVIG 剂量之间，患者接受利妥昔单抗（375 mg/m）。在完成该程序后 1 个月和 2 个月后检测抗 HLA。
所有患者均已完成该方案。脱敏后，同种异体抗体的数量/谱未发生明显变化。然而，由于 HLA-A/B/DR 的 vCM 为阴性（针对报告供体无 DSA）和 CM-CDC 为阴性，根据分配系统，患者在受者名单上获得优先权。13 名患者中有 7 名在治疗后 12 个月内（平均 11.5 周）接受了移植。肾移植物功能良好（1 个月后平均肌酐水平：1.5 mg/dL）。未报告急性排斥反应事件。最常见的并发症是感染（尤其是肺炎）。
脱敏方案（IVIG+利妥昔单抗）允许高度免疫的患者进行器官移植。在短期分析中，未观察到急性排斥反应，移植物功能令人满意。脱敏与感染风险增加有关。
