Huh KH, Kim SI, Joo DJ, Ju MK, Chang HK, Kim HJ, Kim YS, Kim MS
Efficacy of a negative conversion trial and subsequent living donor kidney transplant outcome in recipients with a positive lymphocyte crossmatch. [Clinical Trial, Journal Article]
Nephron Clin Pract 2009; 111(1):c49-54.
BACKGROUND: Patients with a positive lymphocyte crossmatch (LCX) do not undergo kidney transplantation. In such patients, a negative conversion protocol consisting of intravenous immunoglobulin (IVIG), plasmapheresis, and potent immunosuppressant is one of the options for transplantation.
METHODS: 14 patients who showed a positive LCX with living donors underwent a trial of negative conversion between January 2002 and July 2007. Plasmapheresis was performed every other day, up to 6 times maximum. IVIG was infused after plasmapheresis, with a total dose of 500 mg/kg divided over 6 days. Kidney transplantation was performed immediately after negative conversion. Anti-thymocyte globulin (ATG) or OKT3 induction therapy was used with the combination of tacrolimus, mycophenolate mofetil, and prednisone in the perioperative period.
RESULTS: Negative conversion of LCX was achieved in 13 of 14 patients (92.9%). Transplantations were performed successfully in these 13 patients without hyperacute rejection. Four recipients developed acute rejection, which was well controlled by steroid pulse therapy. During the follow-up periods of 45.4 +/- 22.0 months, all recipients except 1 showed excellent graft function.
CONCLUSION: Selected patients with a positive LCX can undergo successful transplantation using plasmapheresis, IVIG, and potent immunosuppressants. Recipients with negative conversion of LCX showed acceptable posttransplant results.
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