Kidney Week

Abstract: FR-PO1209

Assessment of Efficacy and Safety of Desensitization Therapy with Intravenous Immunoglobulin in Preformed Donor-Specific Antibody-Positive Kidney Transplant Patients

Session Information

• Transplantation: Clinical - Rejection, Biomarkers, and Pharmacology
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Naka, Tomoya, Kansai Ika Daigaku, Hirakata, Osaka Prefecture, Japan

Tomoya Naka, DrMed

• Matsushita, Jun, Kansai Ika Daigaku, Hirakata, Osaka Prefecture, Japan

Jun Matsushita, MD

• Ueda, Hiroko, Kansai Ika Daigaku, Hirakata, Osaka Prefecture, Japan

Hiroko Ueda

• Someya, Kazunori, Kansai Ika Daigaku, Hirakata, Osaka Prefecture, Japan

Kazunori Someya

• Pham, Xuyen Thi, Kansai Ika Daigaku, Hirakata, Osaka Prefecture, Japan

Xuyen Thi Pham, MD

• Yanishi, Masaaki, Kansai Ika Daigaku, Hirakata, Osaka Prefecture, Japan

Masaaki Yanishi, MD, PhD

• Kinoshita, Hi, Kansai Ika Daigaku, Hirakata, Osaka Prefecture, Japan

Hi Kinoshita

• Tsukaguchi, Hiroyasu, Kansai Ika Daigaku, Hirakata, Osaka Prefecture, Japan

Hiroyasu Tsukaguchi, MD, PhD

Background

Kidney transplant recipients with pre-existing donor-specific antibodies (DSAs) are at high risk of graft failure due to antibody-mediated rejection (ABMR). Currently, widely used methods for DSA desensitization therapy include plasma exchange and combination therapy with low- or high-dose intravenous immunoglobulin (IVIG) and rituximab (RTX anti-CD20 antibody). However, further investigation is still needed regarding how to optimize administration protocols to balance insufficient (rejection) vs excessive immunosuppression (infections).

Methods

We conducted a longitudinal follow-up study over 0.5 to 8 years (median 4) to evaluate the outcomes and complications of 80 living donor kidney transplants (ages 15-76 years, median 48) performed at our institution between 2017 and 2024. outcomes included histological rejection (ABMR or TCMR) as well as graft and patient survival rates. HLA antibodies were screened using PRA, FCXM (MFI > 500-3000), and Luminex single-antigen bead assays.

Results

Anti-HLA antibodies were detected in 44% of all recipients (35 of 80), in whom 12 cases were DSA-positive and 23 were DSA-negative. As preoperative desensitization therapy, combination therapy (RTX + IVIG group) was administered to nine DSA-positive cases, whereas RTX monotherapy (RTX group) was administered to twenty-three DSA-negative cases. The incidence of ABMR or TCMR in the DSA-positive (RTX+IVIG) group was 22% (2 out of 9 cases), which was even lower than that in the DSA-negatibe (RTX) group (39%, 9 out of 23 cases). No graft loss was observed in the DSA-positive (RTX+IVIG) group during the 5 years post-transplant, and they maintained function with an eGFR of 40 ml/min/1.73m² and mild proteinurea of 0.3g/gCr (median). Among the 9 DSA-positive with administration of RTX and IVIG and sero-negative cytomegalovirus (CMV), four developed CMV infection within 3 months postoperatively despite the prophylactic antiviral therapy.

Conclusion

Desensitization therapy with IVIG and RTX contributes to the prevention of ABMR in the short term in DSA-positive kidney transplant and graft survival. Further studies are needed to evaluate the efficacy of the current protocol and the long-term prognosis related to chronic kidney disease.