Bootcongres

Introduction In the Netherlands 5 – 10% of the kidney transplant recipients are highly immunized. Despite the current transplantation programs and strategies, a number of pre-sensitized patients have to wait for a long time. Their chances for a successful transplantation are negligible. This particular group of patients can benefit from interventions aimed at desensibilization.

Method Eligible patients who have a positive crossmatch with their potential living donor can be enrolled in the desensitization program prior to transplantation. This treatment consists of 5 – 10 plasmafiltration sessions every other day, followed by administration of low dose intravenous immuneglobulin (IVIG) after each session. After the 5^th and 10^th session the crossmatch test will be re-measured. If the crossmatch test has become negative, the patient will be transplanted within 24 hours. The desensibilization is performed at our dialysis unit and can be combined with hemodialysis, if necessary. 

Results We started with this program in 2012 as the first center in The Netherlands. A total of four patients underwent desensibilization. The first patient successfully completed the desensitization program and could be transplanted. Her kidney function is stable after 8 months. The second patient had to discontinue treatment due to intravascular catheter-related infection. In the third patient, treatment resulted in a reduction of the degree of sensitization, but unfortunately a negative crossmatch could not be achieved. The last patient discontinued the treatment at his own request. 

Conclusions The desensibilization treatment consisting of plasmafiltration and IVIG infusion, is a feasible solution for pre-sensitized kidney transplant recipients, and can be combined with hemodialysis. A close collaboration between different disciplines (transplantation, dialysis, pharmacy, HLA laboratory and surgery) is warranted in order to achieve success. Executed for the first time in The Netherlands, this method provides perspective on successful kidney transplantation for a group of highly immunized patients for whom the current chances are practically nil.