SP698
OUTCOMES FOLLOWING LIVING DONOR KIDNEY TRANSPLANTATION IN PATIENTS WITH DONOR-SPECIFIC HLA ANTIBODIES AFTER DESENSITIZATION WITH IMMUNOADSORPTION

INTRODUCTION AND AIMS: Due to the current organ shortage, living donor kidney transplantation is increasingly performed over human leukocyte antigen (HLA) or ABO antibody barriers. Uncertainty still exists concerning the risk for antibody-mediated rejection episodes, possibly limiting long-term graft survival. The present study aimed to evaluate the outcomes of kidney transplantations performed after desensitization in patients with donor-specific HLA antibodies compared to standard risk recipients.

METHODS: Thirty-seven sensitized patients were included in the study. Sixteen patients had a positive CDC and/or ELISA crossmatch result with their prospective living donor and 31 patients had Luminex-detected donor-specific HLA antibodies (DSA). Patients were successfully desensitized by immunoadsorption treatment (median of 8 treatments) and anti-CD20 antibody rituximab (N=32) combined with antithymocyte globulin (N=19) or anti-IL2 receptor antibody therapy (N=18). Eleven patients were additionally treated by plasmapheresis. All patients received a kidney transplant from a living donor. Postoperative apheresis was performed in 35 patients. The outcomes of the 37 patients were retrospectively compared to outcomes of 74 standard risk recipients (2:1 matching).

RESULTS: During a median of 8 pretransplant immunoadsorption treatments, IgG was reduced by 98% and IgM by 78% in sensitized patients. After transplantation, sensitized patients showed comparable death-censored graft survival and patient survival compared to standard risk recipients. Infectious complications, surgical complications and rejection rates (19% in both groups) were not significantly different between groups. Median 1-year serum creatinine was with 1.31 mg/dL in sensitized recipients not significantly different to the 1.38 mg/dL in standard risk recipients. One-year urinary protein excretion was also not significantly different with a low 10.8 and 10.5 g/mol creatinine, respectively.

CONCLUSIONS: Our desensitization protocol for sensitized living donor kidney transplant recipients results in good graft outcomes with comparable side effects and rejections rates to standard risk recipients.