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Efficacy of a negative conversion trial and subsequent living donor kidney transplant outcome in recipients with a positive lymphocyte crossmatch

Authors
 Kyu Ha Huh  ;  Soon Il Kim  ;  Dong Jin Joo  ;  Man Ki Ju  ;  Hye Kyung Chang  ;  Hae Jin Kim  ;  Yu Seun Kim  ;  Myoung Soo Kim 
Citation
 NEPHRON, Vol.111(1) : 49-54, 2009 
Journal Title
 NEPHRON 
ISSN
 1660-8151 
Issue Date
2009
MeSH
Adult ; Antilymphocyte Serum/therapeutic use ; B-Lymphocytes/immunology ; Female ; Graft Rejection/etiology ; Graft Rejection/prevention & control ; Histocompatibility Testing* ; Humans ; Immunoglobulins, Intravenous/therapeutic use* ; Immunosuppression/methods* ; Immunosuppressive Agents/therapeutic use* ; Isoantibodies/blood* ; Kidney Transplantation/immunology* ; Living Donors* ; Male ; Middle Aged ; Muromonab-CD3/therapeutic use ; Mycophenolic Acid/administration & dosage ; Mycophenolic Acid/analogs & derivatives ; Mycophenolic Acid/therapeutic use ; Plasmapheresis* ; Prednisone/administration & dosage ; Prednisone/therapeutic use ; Premedication ; Preoperative Care/methods* ; Reoperation ; T-Lymphocytes/immunology ; Tacrolimus/administration & dosage ; Tacrolimus/therapeutic use ; Transplantation, Homologous/immunology* ; Treatment Outcome
Keywords
Intravenous immunoglobulin ; Kidney transplantation ; Plasmapheresis ; Positive lymphocyte crossmatch
Abstract
BACKGROUND: Patients with a positive lymphocyte crossmatch (LCX) do not undergo kidney transplantation. In such patients, a negative conversion protocol consisting of intravenous immunoglobulin (IVIG), plasmapheresis, and potent immunosuppressant is one of the options for transplantation. METHODS: 14 patients who showed a positive LCX with living donors underwent a trial of negative conversion between January 2002 and July 2007. Plasmapheresis was performed every other day, up to 6 times maximum. IVIG was infused after plasmapheresis, with a total dose of 500 mg/kg divided over 6 days. Kidney transplantation was performed immediately after negative conversion. Anti-thymocyte globulin (ATG) or OKT3 induction therapy was used with the combination of tacrolimus, mycophenolate mofetil, and prednisone in the perioperative period. RESULTS: Negative conversion of LCX was achieved in 13 of 14 patients (92.9%). Transplantations were performed successfully in these 13 patients without hyperacute rejection. Four recipients developed acute rejection, which was well controlled by steroid pulse therapy. During the follow-up periods of 45.4 +/- 22.0 months, all recipients except 1 showed excellent graft function. CONCLUSION: Selected patients with a positive LCX can undergo successful transplantation using plasmapheresis, IVIG, and potent immunosuppressants. Recipients with negative conversion of LCX showed acceptable posttransplant results
Full Text
http://www.karger.com/Article/FullText/178979
DOI
10.1159/000178979
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Kim, Soon Il(김순일) ORCID logo https://orcid.org/0000-0002-0783-7538
Kim, Yu Seun(김유선) ORCID logo https://orcid.org/0000-0002-5105-1567
Chang, Hye Kyung(장혜경)
Joo, Dong Jin(주동진) ORCID logo https://orcid.org/0000-0001-8405-1531
Joo, Man Ki(주만기) ORCID logo https://orcid.org/0000-0002-4112-7003
Huh, Kyu Ha(허규하) ORCID logo https://orcid.org/0000-0003-1364-6989
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/103518
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