Management of sensitized pediatric patients prior to renal transplantation

Pediatric Nephrology : Journal of the International Pediatric Nephrology Association
Kwanchai PirojsakulMouin G Seikaly

Abstract

Data on renal allograft outcome in sensitized children are scarce. We report the clinical courses of four children who received desensitization therapy prior to renal transplantation in our institution. Between 2009 and 2011, four pediatric patients with stage 5 chronic kidney disease received desensitization therapy due to: (1) positive donor-specific antibodies (DSA) and/or crossmatches with potential living donors, (2) more than three positive crossmatches with deceased donors or (3) high calculated panel-reactive antibody of >80 %. Desensitization with rituximab, intravenous immunoglobulin and bortezomib was performed in all patients. Induction therapy included combinations of plasmapheresis and/or alemtuzumab or anti-thymocyte globulin. Standard post-transplant medications included tacrolimus, mycophenolate mofetil and prednisolone. Post-transplant screening revealed DSA in three patients. Biopsy showed no evidence of rejection at 1 month in two patients, one of whom developed chronic active antibody-mediated rejection 4.5 years later. One patient developed borderline acute cellular rejection at 1 month, but the serum creatinine level was stable and DSA disappeared without treatment 1 month later, with stable long-term all...Continue Reading

References

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Nov 28, 2013·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Khurrum SiddiqueMouin G Seikaly
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Citations

Jun 9, 2016·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Nizam Mamode, Stephen D Marks
Sep 7, 2016·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·M P SypekJ Y Kausman
Apr 12, 2017·Pediatric Transplantation·H C YaffeL K Kayler
Jan 15, 2018·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Ankit Sharma, Anne M Durkan
Jul 3, 2017·Clinical Pharmacokinetics·Marieke van der ZwanDennis A Hesselink
May 16, 2021·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Shweta ShahPoyyapakkam Srivaths

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