Abstract: SA-PO474
Highly Sensitized Patients at Miami Transplant Institute: An Update
Session Information
- Transplantation: Balancing Rejection and Infection
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Cortesi, Camilo, University of Miami/Jackson Memorial Hospital , Miami, Florida, United States
- Sedki, Mai, University of Miami/Jackson Memorial Hospital , Miami, Florida, United States
- Guerra, Giselle, University of Miami/Miller School of Medicine, Miami, Florida, United States
- Contreras, Gabriel, University of Miami , Miami, Florida, United States
- Mattiazzi, Adela D., University of Miami/Jackson Memorial Hospital , Miami, Florida, United States
Background
Highly sensitized (HS) patients are defined as transplant candidates sensitized against human leukocyte antigen (HLA) antibodies with a panel reactive antibody (PRA) greater than 80%. This has been a major obstacle to kidney transplantation (KT). Major causes are blood transfusions, pregnancy and prior transplants. HS patients have an increased risk of rejection, worse graft survival, and less annual transplant rates. There are different strategies available for desensitization including intravenous immunoglobulin (IVIG), plasmapheresis (PE), and Rituximab (R). We provide an update of our experience comparing patients undergoing desensitization.
Methods
This is a retrospective analysis of 50 HS KT recipients categorized into 2 groups based on induction immunosuppression received at transplantation. The control group (CG), 12 HS KTs, received standard induction. The Rituximab group (RG), 38 HS KTs, received standard induction as well as R ± IVIg ± PE based on the immunological risk stratification model. The primary outcomes were defined as rejection rate, allograft failure, and death. Secondary outcomes assessed graft function via serum creatinine at various times post-transplant.
Results
The number of HLA mismatches was not statistically different between the 2 groups. In the CG, 75% had prior transplants compared to 53% in the RG. Mean waiting time for KT was 7.6 years and 5.4 years for the CG and RG, respectively (p=0.007). The cumulative proportion of patients who remained free of death or allograft failure was significantly higher in the RG (87%) compared to the CG (60%)(p=0.039). The probability of rejection was similar in both groups (p=0.36). The mean serum creatinine at 1 year was 1.35 ± 0.54 and 1.36 ± 0.64 mg/dL for the CG and RG, respectively.
Conclusion
Desensitization strategies are fundamental for the management of the HS population. Our study confirms that the addition of R continues to improve allograft survival and decrease death rates.
| Control Group | Rituximab Group | |
| Age, (years) mean ± SE Gender, n (%) Patients with Prior Transplantation, n (%) | 52 ± 18.5 6 (50) male, 6 (50) female 9 (75) | 49 ± 15 12 (32) male, 26 (68) female 20 (53) |
| Total HLA mismatch level, n (%) 6 5 4 3 2 1 0 | 3 (25) 4 (33) 4 (33) 0 0 0 1 (9) | 5 (13) 20 (52) 9 (24) 4 (11) 0 0 0 |
| DR HLA mismatch level, n (%) 2 1 0 | 5 (41) 6 (50) 1 (9) | 23 (61) 13 (34) 2 (5) |
| PRA at IVIg Treatment, mean ± SE PRA at Transplant, mean ± SE | 96.9 ± 5.2 84 ± 20.4 | 91 ± 22.6 87 ± 15 |
| Time to Transplantation in days, median (95% confidence interval) | 2346 (1914 – 3648) | 1553 (1539 – 2425) |
| High Risk Level [1, 2, 3], n (%) Delayed Graft Function, n (%) Plasmapheresis, n (%) | 9 (75), 2 (16), 1(9) 2 (16) 0 | 18 (47), 14 (37), 6 (16) 7 (18) 8 (21) |
| Rejection, n (%) Allograft Failure, n (%) Death, n (%) | 3 (25) 2 (17) 2 (17) | 10 (26) 2 (5) 2 (5) |