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Kidney transplantation after desensitization in sensitized patients: a Korean National Audit

  • Nephrology – Original Paper
  • Published:
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Abstract

Introduction

The number of end-stage renal disease (ESRD) patients with preformed antibodies waiting for a kidney transplant has been increasing lately. We conducted a nationwide study on the outcomes of kidney transplantation after desensitization in Korea.

Methods

Six transplant centers have run desensitization programs. The patients who underwent living donor kidney transplantation after desensitization from 2002 to 2010 were retrospectively analyzed.

Results

A total of 86 cases were enrolled. Thirty-five of these were cases of re-transplantation (40.7 %). Indications of desensitization were positive complement-dependent cytotoxicity (CDC) cross-match responses (CDC+, 36.0 %), positive flow-cytometric cross-match responses (FCX+, 54.7 %), and positive donor-specific antibodies (DSA+, 8.1 %). The desensitization protocols used pre-transplant plasmapheresis (95.3 %), intravenous immunoglobulin (62.8 %), and rituximab (67.4 %). Acute rejection occurred in 18 patients (20.9 %), graft failure occurred in 4 patients, and the 3-year graft survival rate was 93.8 %. The presence of DSA increased the acute rejection rate (P = 0.015) and decreased the 1-year post-transplant estimated glomerular filtration rate (P = 0.006). Although rejection-free survival rates did not differ significantly between the CDC+ and FCX+ groups, the 1-year estimated glomerular filtration rate was lower in the CDC+ group (P = 0.010). Infectious and significant bleeding complications occurred in 15.5 % and 4.7 % of cases, respectively.

Conclusion

Kidney transplantation after desensitization had good graft outcomes and tolerable complications in Korea, and therefore, this therapy can be recommended for sensitized ESRD patients.

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Acknowledgments

The authors thank Dr. Won Hyun Cho, Curie Ahn and Sung Joo Kim for their support. This work was supported by the Korean Society for Transplantation Fund.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea

    Kyu Ha Huh

  2. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    Beom Seok Kim

  3. Transplantation Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Republic of Korea

    Jaeseok Yang & Myung-Gyu Kim

  4. Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

    Jaeseok Yang

  5. Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea

    Jeongmyung Ahn & Jin Min Kong

  6. Department of Surgery, University of Ulsan College of Medicine, Seoul, South Korea

    Jae Berm Park

  7. Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Jong Man Kim

  8. Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea

    Byung-Ha Chung

  9. Department of Medicine, Bong Seng Hospital, Busan, Korea

    Joong Kyung Kim

Authors
  1. Kyu Ha Huh
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  9. Joong Kyung Kim
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Corresponding author

Correspondence to Jaeseok Yang.

Additional information

Kyu Ha Huh and Beom Seok Kim equally contributed to this work.

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Huh, K.H., Kim, B.S., Yang, J. et al. Kidney transplantation after desensitization in sensitized patients: a Korean National Audit. Int Urol Nephrol 44, 1549–1557 (2012). https://doi.org/10.1007/s11255-012-0169-1

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  • DOI: https://doi.org/10.1007/s11255-012-0169-1

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