2016 Volume 4 Issue 1 Pages 83-91
Desensitization with high dose intravenous immune globulin (IVIG), rituximab and plasmapheresis (PP), etc, significantly improves successful transplant rates in patients with donor specific HLA antibodies (DSA), but antibody-mediated rejection (AMR) including subclinical AMR remains a concern. Between April 2008 and December 2014, we performed 592 living donor kidney transplants (no DSA and ABO compatible (ABOc) (n＝374), no DSA and ABO incompatible (ABOi) (n＝180), pre DSA (n＝38)). 38 sensitized patients that received transplants after desensitization using mycophenolate mofetil, Rit and PP. DSA was detected via flow cytometry crossmatch (FCXM) and single-antigen beads (mean fluorescence intensity＞1,000). 36 of the 38 patients with pre DSA underwent over one year protocol biopsies. Among pre DSA groups, 5-year graft survival rate was 86.1％, acceptably. However, 5-year CAMR free rate was 34.6％, unacceptably. Further study on effective desensitization and treatment for subclinical CAMR is necessary.
