Successful A2 to B Deceased Donor Kidney Transplant after Desensitization for High-Strength Non-HLA Antibody Made Possible by Utilizing a Hepatitis C Positive Donor.

Autor: Karpel HC; Transplant Institute, NYU Langone Health, New York, NY, USA., Ali NM; Transplant Institute, NYU Langone Health, New York, NY, USA., Lawson N; Transplant Institute, NYU Langone Health, New York, NY, USA., Tatapudi VS; Transplant Institute, NYU Langone Health, New York, NY, USA., Friedlander R; The Rogosin Institute, New York, NY, USA., Philogene MC; American Red Cross, Penn Jersey Region, Philadelphia, PA, USA., Montgomery RA; Transplant Institute, NYU Langone Health, New York, NY, USA., Lonze BE; Transplant Institute, NYU Langone Health, New York, NY, USA.
Jazyk: angličtina
Zdroj: Case reports in transplantation [Case Rep Transplant] 2020 Mar 13; Vol. 2020, pp. 3591274. Date of Electronic Publication: 2020 Mar 13 (Print Publication: 2020).
DOI: 10.1155/2020/3591274
Abstrakt: Desensitization using plasma exchange can remove harmful antibodies prior to transplantation and mitigate risks for hyperacute and severe early acute antibody-mediated rejection. Traditionally, the use of plasma exchange requires a living donor so that the timing of treatments relative to transplant can be planned. Non-HLA antibody is increasingly recognized as capable of causing antibody-mediated renal allograft rejection and has been associated with decreased graft longevity. Our patient had high-strength non-HLA antibody deemed prohibitive to transplantation without desensitization, but no living donors. As the patient was eligible to receive an A2 ABO blood group organ and was willing to accept a hepatitis C positive donor kidney, this afforded a high probability of receiving an offer within a short enough time frame to attempt empiric desensitization in anticipation of a deceased donor transplant. Fifteen plasma exchange treatments were performed before the patient received an organ offer, and the patient was successfully transplanted. Hepatitis C infection was treated posttransplant. No episodes of rejection were observed. At one-year posttransplant, the patient maintains good graft function. In this case, willingness to consider nontraditional donor organs enabled us to mimic living donor desensitization using a deceased donor.
Competing Interests: The authors have no conflicts of interest to disclose.
(Copyright © 2020 H. Charli Karpel et al.)
Databáze: MEDLINE
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