Desensitization protocols for prospective pediatric renal transplant recipients

Abstract

Desensitization protocols should be considered for children with positive crossmatches awaiting renal transplantation. Children are sensitized usually due to previous renal (and/or other solid-organ) transplants but can be from administration of blood and/or platelet transfusions, infections, and immunizations (as sensitization from pregnancy is a rare occurrence in pediatric patients). However, the definition of HLA-incompatible (HLAi) renal transplantation in the literature varies and is best considered only when there is a positive cross-match (positive baseline flow cytometric cross-match or positive complement-dependent cytotoxic cross-match). Renal transplantation where the recipient has donor-specific antibodies (DSA) but a negative cross-match should not fall into this category, although they are higher risk.

Modelling acute antibody-mediated rejection of human kidney transplants using ex-vivo warm machine perfusion

“…Direct HLA incompatible (HLAi) or ABO incompatible (ABOi) transplantation may be offered to highly sensitised patients or those with an ABO-incompatible living donor. 13 , 14 This involves removing anti-blood group antibodies and/or HLA antibodies from the recipient, prior to transplantation—effectively “desensitizing” the patient to allow safe transplantation to take place. Typically, this is feasible only in patients with lower titres of anti-donor antibodies.…”