Management of Patients on the Waiting List for Deceased Donor Kidney Transplantation

Kim, M.G.; Ro, Han; Kim, Y.J.; Park, H.C.; Jeong, Jong Cheol; Jeon, Hyeon‐Gu; Kim, H.; Park, M.W.; Oh, Kwang Ho; Kim, Yong Se; Ahn, Curie; Yang, Jaeseok

doi:10.1016/j.transproceed.2011.12.020

Cited by 6 publications

(2 citation statements)

References 19 publications

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“…1 Moreover, highly sensitized patients are prone to have longer waiting times and lower transplant rates because of a positive crossmatch response. 2 Highly sensitized patients form a significant percentage (16.8%) of kidney wait-listed patients in Korea, which poses an important clinical problem. 3…”

Section: Introductionmentioning

confidence: 99%

Desensitization Using Bortezomib and High-dose Immunoglobulin Increases Rate of Deceased Donor Kidney Transplantation

Jeong

Jambaldorj

Kwon³

et al. 2016

Medicine

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Combination therapy of intravenous immunoglobulin (IVIG) and rituximab showed a good transplant rate in highly sensitized wait-listed patients for deceased donor kidney transplantation (DDKT), but carried the risk of antibody-mediated rejection. The authors investigated the impact of a new combination therapy of bortezomib, IVIG, and rituximab on transplantation rate.This study was a prospective, open-labeled clinical trial. The desensitization regimen consisted of 2 doses of IVIG (2 g/kg), a single dose of rituximab (375 mg/m2), and 4 doses of bortezomib (1.3 mg/m2). The transplant rate was analyzed. Anti-Human leukocyte antigen (HLA) DRB antibodies were determined by a Luminex solid-phase bead assay at baseline and after 2, 3, and 6 months in the desensitized patients.There were 19 highly sensitized patients who received desensitization and 17 patients in the control group. Baseline values of class I and II panel reactive antibody (%, peak mean fluorescence intensity) were 83 ± 16.0 (14952 ± 5820) and 63 ± 36.0 (10321 ± 7421), respectively. Deceased donor kidney transplantation was successfully performed in 8 patients (42.1%) in the desensitization group versus 4 (23.5%) in the control group. Multivariate time-varying covariate Cox regression analysis showed that desensitization increased the probability of DDKT (hazard ratio, 46.895; 95% confidence interval, 3.468–634.132; P = .004). Desensitization decreased mean fluorescence intensity values of class I panel reactive antibody by 15.5% (20.8%) at 2 months. In addition, a liberal mismatch strategy in post hoc analysis increased the benefit of desensitization in donor-specific antibody reduction. Desensitization was well tolerated, and acute rejection occurred only in the control group.In conclusion, a desensitization protocol using bortezomib, high-dose IVIG, and rituximab increased the DDKT rate in highly sensitized, wait-listed patients.

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Section: Introductionmentioning

confidence: 99%

Desensitization Using Bortezomib and High-dose Immunoglobulin Increases Rate of Deceased Donor Kidney Transplantation

Jeong

Jambaldorj

Kwon³

et al. 2016

Medicine

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“…Graft outcomes of ECD kidneys have been reported to be worse than those of standard criteria donor (SCD) kidneys . In practice, the most common cause of refusal of an allocated kidney in a Korean center was refusal of an ECD kidney . However, outcomes of ECD kidneys were comparable to those of SCD kidneys in a Korean study , and short, cold ischemic time (CIT) is thought to explain the good ECD outcomes observed .…”

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confidence: 98%

Kidney donor risk index is a good prognostic tool for graft outcomes in deceased donor kidney transplantation with short, cold ischemic time

Jeong

Koo

Jeon

et al. 2014

Clinical Transplantation

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Presence of a survival benefit of HLA-incompatible living donor kidney transplantation compared to waiting or HLA-compatible deceased donor kidney transplantation with a long waiting time

Koo

Lee

Min

et al. 2021

Kidney International

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Management of Patients on the Waiting List for Deceased Donor Kidney Transplantation

Cited by 6 publications

References 19 publications

Desensitization Using Bortezomib and High-dose Immunoglobulin Increases Rate of Deceased Donor Kidney Transplantation

Desensitization Using Bortezomib and High-dose Immunoglobulin Increases Rate of Deceased Donor Kidney Transplantation

Kidney donor risk index is a good prognostic tool for graft outcomes in deceased donor kidney transplantation with short, cold ischemic time

Presence of a survival benefit of HLA-incompatible living donor kidney transplantation compared to waiting or HLA-compatible deceased donor kidney transplantation with a long waiting time

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