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Imlifidase in Highly Sensitized Kidney Transplant Recipients With a Positive Crossmatch Against a Deceased Donor.
Kidney Int Rep
October 2024
Bordeaux University Hospital, Department of Nephrology, Transplantation, Dialysis and Apheresis, UMR-CNRS5164 Immunoconcept, University of Bordeaux, Bordeaux, France.
Article Synopsis
- Imlifidase is used for desensitizing highly sensitized adult kidney transplant candidates with a positive crossmatch against deceased donors, and results from the first 9 patients are reported after at least 3 months of follow-up.
- All 9 patients had been on dialysis for an average of over 10 years, and after treatment with imlifidase, all patients showed negative results for donor-specific antibodies (DSAs) that could have restricted their transplant eligibility.
- The study concludes that imlifidase appears to be effective and safe for desensitization in these patients, with no graft losses or deaths reported, although some patients did experience infections and DSA rebounds.
Anti-HLA Class II Antibodies Are the Most Resistant to Desensitization in Crossmatch-positive Living-donor Kidney Transplantations: A Patient Series.
Transplant Direct
September 2024
Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands.
Background: In HLA-incompatible kidney transplantation, the efficacy of desensitization in terms of anti-HLA antibody kinetics is not well characterized. We present an overview of the course of anti-HLA antibodies throughout plasma exchange (PE) desensitization in a series of crossmatch-positive patients.
Methods: All consecutive candidates in the Dutch HLA-incompatible kidney transplantation program between November 2012 and January 2022 were included.
Article Synopsis
- * Eligible candidates must have a calculated panel reactive antibody (cPRA) of 98% or higher, be under 65 years old, have been on the waiting list for at least three years, and have a low risk of biopsy complications.
- * The treatment requires a negative post-Imlifidase crossmatch and a strong negative virtual crossmatch, and patients will undergo a specific immunosuppressive regimen along with ongoing monitoring for donor-specific antibodies and potential rejection.
Optimal induction strategy in highly sensitized kidney transplant recipients (KTRs) is still a matter of debate. The place of therapies, such as plasma exchange and rituximab, with potential side effects and high cost, is not clearly established. We compared two induction strategies with (intensive) or without (standard) rituximab and plasma exchange in KTRs with high levels of preformed DSA transplanted between 2012 and 2019.
View Article and Find Full Text PDFDonor-specific antibody (DSA) responses against human leukocyte antigen (HLA) proteins mismatched between kidney transplant donors and recipients cause allograft loss. The rules governing the immunogenicity of non-self donor HLA are poorly understood. Using single-cell, molecular, structural, and proteomic techniques, we profiled the HLA-specific B cell response in the kidney and blood of a transplant recipient with antibody-mediated rejection (AMR).
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