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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.
Sequential administration of anti-complement component C5 eculizumab and type-2 anti-CD20 obinutuzumab for the treatment of early antibody-mediated rejection after kidney transplantation: A proof of concept.
Clin Immunol
July 2024
General Surgery and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy.
Kidney transplant (KT) candidates with donor-specific antibodies (DSA) exhibit exceedingly high antibody-mediated rejection (ABMR) and allograft loss rates. Currently, treatment of ABMR remains an unmet clinical need. We report the use of the anti-C5 eculizumab and the type-2 anti-CD20 obinutuzumab in two patients with early ABMR.
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- * 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.
Double-Filtration Plasmapheresis Plus Low-Dose Anti-thymocyte Globulin and Tacrolimus in Asian Living-Donor Kidney Transplantation With Donor-Specific Anti-HLA Antibody.
Transplant Proc
April 2021
Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Ramathibodi Hospital, Phyathai, Bangkok, Thailand.
Background: Pretransplant desensitization protocols, including plasmapheresis, intravenous immunoglobulin, induction antibody therapy, and intensive maintenance immunosuppression, are generally employed in kidney transplant recipients who have positive status for donor-specific anti-HLA antibody (DSA). To avoid serious infectious complications, the authors designed a novel low-dose protocol in Thai patients undergoing DSA+ living-related kidney transplantation (LRKT).
Methods: A retrospective cohort study of the patients who underwent DSA+ LRKT was conducted.
Desensitizing highly sensitized heart transplant candidates with the combination of belatacept and proteasome inhibition.
Am J Transplant
December 2020
Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.
HLA antibodies pose a significant barrier to transplantation and current strategies to reduce allosensitization are limited. We hypothesized that augmenting proteasome inhibitor (PI) based desensitization with costimulation blockade (belatacept) to mitigate germinal center (GC) responses might increase efficacy and prevent rebound. Four highly sensitized (calculated panel reactive antibody [cPRA] class I and/or II >99%, complement-dependent cytotoxicity panel reactive antibody [CDC PRA+], C1q+) heart transplant candidates were treated with the combination of belatacept and PI therapy, which significantly reduced both class I and II HLA antibodies and increased the likelihood of identifying an acceptable donor.
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