Optimizing HLA matching in a highly sensitized pediatric patient using ABO-incompatible and paired exchange kidney transplantation

Pediatric Nephrology : Journal of the International Pediatric Nephrology Association
Anjali B NayakEileen W Tsai

Abstract

Kidney transplantation is the treatment of choice for end-stage renal disease. However, since pediatric patients have long projected life-years, it is also optimal for them to get well-matched transplants to minimize long-term sensitization. In North America, pediatric kidney transplantation is largely dependent upon the use of deceased donor organs, making it challenging to identify timely, well-matched transplants. Pediatric recipients may have willing living donors who are either HLA- or ABO-incompatible (ABOi); therefore, one solution is to utilize ABOi transplants and paired exchange programs to enhance HLA matching and living donation. We adopted this approach for a highly sensitized patient with cPRA 90%, who received a successful ABOi paired exchange transplant. The recipient received pre-transplant immunomodulation until an acceptable isohemagglutinin titer <1:8 was reached before transplantation. The patient was induced with anti-thymocyte globulin and maintained on steroid-based triple immunosuppression. Eighteen-month allograft function is excellent with an estimated glomerular filtration rate (eGFR) of 83.53 ml/min/1.73 m(2). The patient did not develop de novo donor-specific HLA antibodies or have any episodes of ...Continue Reading

References

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Mar 13, 2014·Pediatrics·Kyle J Van ArendonkDorry L Segev

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Citations

Jun 22, 2015·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Simon A Carter, Joshua Y Kausman
Sep 3, 2016·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Anna M AdamusiakNizam Mamode
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 14, 2017·Transplant International : Official Journal of the European Society for Organ Transplantation·Bonnie E LonzeRobert A Montgomery
May 22, 2018·Transplantation·Motoshi HattoriUNKNOWN Japan Society for Transplantation and Japanese Society for Clinical Renal Transplantation
Dec 23, 2016·Frontiers in Immunology·Andrea A Zachary, Mary S Leffell

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