Renal transplantation in sensitized children and young adults: A nationwide approach

Luca Dello Strologo, Luisa Murer, Isabella Guzzo, Federica Morolli, Annalisa Maria Valeria Pipicelli, Elisa Benetti, Germana Longo, Sara Testa, A. Ricci, Fabrizio Ginevri, Luciana Ghio, Massimo Cardillo, Antonina Piazza, Alessandro Nanni Costa

Research output: Contribution to journalArticle

Abstract

Background. High levels of preformed anti-HLA antibodies dramatically diminish renal transplant outcomes.Most desensitization programmes guarantee good intermediate outcomes but quite disappointing long-term prognosis. The search for a fully compatible kidney increases time on the waiting list. Methods. In February 2011, a nationwide hyperimmune programme (NHP) was begun in Italy: all available kidneys are primarily proposed to highly sensitized patients with a panel reactive antibody above 80%. In this manuscript, we evaluate the outcome of paediatric patients transplanted with this approach. Results. Twenty-one patients were transplanted. Complete data are available for 20 patients. Mean age at transplantation was 14.5 years [standard deviation (SD) 6 5.5)]. Mean time on the waiting list was 29.3 months (SD 6 27.5). Median follow-up was 29.2 months (range: 11.2-59.3). The average number of HLA mismatches in these patients was 2.3 versus 3.7 in 48 standard patients transplanted in the same period (P <0.001). Only one graft was lost. Two cases of humoral rejection occurred and were successfully treated. No cellular rejection was reported. Median creatinine clearance was 84, 88, 77 and 77 mL/min/1.73 m2 respectively 1, 6, 12 and 24 months after transplant. Conclusions. Transplantation of sensitized patients avoiding prohibited antigens is feasible, at least in a selected cohort of patients. In order to be able to further improve this approach, which in our opinion is very successful, it would be necessary to expand the donor pool, possibly increasing the number of countries participating in the programme. In this series, time on the waiting list did not increase significantly. This allocation policy should ideally lead to an outcome comparable to that expected in standard patients, which is particularly desirable in young patients who have the longest life expectancy. Since long-term results of desensitization programmes are not (yet) convincing, we suggest that these programmes should be reserved for selected cases where compatible organs cannot be found within a reasonable time span.
Original languageEnglish
Pages (from-to)191-195
Number of pages5
JournalNephrology Dialysis Transplantation
Volume32
Issue number1
DOIs
Publication statusPublished - 2017

Keywords

  • Allocation policy
  • Paediatric
  • Renal transplant
  • Sensitization
  • alloantibody
  • panel reactive antibody
  • HLA antigen
  • adult
  • Article
  • blood group typing
  • child
  • clinical article
  • cohort analysis
  • controlled study
  • creatinine clearance
  • follow up
  • health program
  • hospital admission
  • human
  • Italy
  • kidney graft
  • kidney graft rejection
  • kidney transplantation
  • organ donor
  • protein analysis
  • sensitization
  • young adult
  • adolescent
  • blood
  • chronic kidney failure
  • desensitization
  • female
  • graft survival
  • histocompatibility test
  • immunology
  • male
  • preschool child
  • procedures
  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Desensitization, Immunologic
  • Female
  • Graft Survival
  • Histocompatibility Testing
  • HLA Antigens
  • Humans
  • Isoantibodies
  • Kidney Failure, Chronic
  • Kidney Transplantation
  • Male
  • Young Adult

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  • Cite this

    Dello Strologo, L., Murer, L., Guzzo, I., Morolli, F., Pipicelli, A. M. V., Benetti, E., Longo, G., Testa, S., Ricci, A., Ginevri, F., Ghio, L., Cardillo, M., Piazza, A., & Costa, A. N. (2017). Renal transplantation in sensitized children and young adults: A nationwide approach. Nephrology Dialysis Transplantation, 32(1), 191-195. https://doi.org/10.1093/ndt/gfw369