MO1002: Two-Step Desensitization Protocol Consisting of High-Dose Intravenous Immunoglobulin, Plasmapheresis and Rituximab in Highly Sensitized Kidney Transplantation

High-dose intravenous immunoglobulin (IVIG) therapy has not only immediate effects but also gradual effects via Fc receptors. To optimize IVIG therapy, we adopted a two-step desensitization protocol in kidney transplantation (KTx) with positive flow cytometry crossmatch (FCXM).

In the first step, rituximab 200 mg and IVIG 2 g/kg were administered 2 months before KTx. In the second step, patients received additional rituximab 200 mg and IVIG 2g/kg for 2 weeks prior to transplantation in combination with plasmapheresis.

Of the six KTx with positive FCXM, there was no rejection except one (16.7%) subclinical antibody-mediated rejection within 1 month after transplantation. Average graft function was acceptable (serum creatinine level of 1.17 mg/dL).

The two-step desensitization protocol is an effective option for achieving successful transplant outcomes in KTx with positive FCXM, which can spare more aggressive and expensive treatments, such as C5 inhibitors, proteasome inhibitors and imlifidase.