Successful deceased donor renal transplant in a sensitized pediatric recipient with the use of plasmapheresis

Abstract

Sensitization following renal transplant is a significant barrier to repeat transplantation in children. We report a successful DD renal transplant, with the use of PP, in an 11-yr-old girl who became highly sensitized following a prior failed transplant. She received PP treatments after failure of high-dose IVIg (Gamimune). We established the effectiveness of PP by attaining a 0% PRA and negative cross-matches after five PP treatments. Subsequently, our patient underwent a second round of scheduled PP. When the PRA was 0%, unacceptable antigens were removed from the UNOS wait list, PP was continued, and a kidney became available within 10 days. The final flow cytometry cross-match with the eventual donor was negative. This success demonstrates that coordination of desensitization by PP and advanced laboratory monitoring techniques with recent policies regarding allocation of organs to pediatric patients provides new opportunities for children awaiting transplantation. Since the transplant, our patient sustained a low-titer increase of anti-HLA antibodies. However, she has had no episodes of acute rejection and has maintained excellent graft function more than 17 months later.

Effects of Fructus Akebiae on learning and memory impairment in a scopolamine-induced animal model of dementia

“…to mice and rats 10 min prior to testing at 1 or 10 mg/kg. The FAE extracts (13) were suspended in 5% EtOH (Sigma-Aldrich) in 95% water for oral administration (p.o.) at 2.5, 5, or 10 mg/kg (n=6 animals per treatment), and administered 40 min prior to behavioral tests.…”

Treatment Update of Sensitized Pediatric Kidney Transplant Recipients: A Review

“…They used high-dose IVIG (2 g/kg) every 4 weeks (3 doses each week) but it was not effective. 15 In contrast, Al-Uzri and associates have shown that long-term high-dose IVIG use can change the PRA to zero. 19 They used 500 mg/kg IVIG weekly for 3 consecutive weeks every 12 weeks.…”

“…Some transplant centers do not perform desensitization for patients with AHA-CDC > 1/16. 15,34,35 There are also some problems in treating patients with positive crossmatch reported by different assays Most centers believe that they should check DSA in recipients with positive flow cytometry crossmatch to increase the specificity of this test by other assays such as single antigen beads. Maryland University recommends the desensitizing treatment in patients with negative AHG and positive flow cytometry which anti-DSA are positive.…”

“…These desensitizing methods include high-dose intravenous immunoglobulin (IVIG), [8][9][10][11] plasmapheresis alone, plasmapheresis/low-dose IVIG, [12][13][14] plasmapheresis/rituximab, plasmapheresis/ immunosuppressive agents, 15 immunoadsorption, immunosuppressive medicines such as alkylating agents, and infusion of rituximab. 13,14,16 Each desensitizing protocol has some strengths and weaknesses.…”

Therapeutic plasma exchange for the treatment of pediatric renal diseases in 2013

“…A recent series of adult patients with end-stage renal disease (ESRD) demonstrated that patients who underwent desensitization with TPE and IVIG followed by living donor kidney transplantation had significantly improved survival than those who remained on dialysis and waited for an HLA-compatible deceased donor [9]. Desensitization is not well studied among children, but TPE allowed a successful second renal transplant in an 11 year-old girl whose PRA was not sufficiently reduced with high-dose IVIG [10]. Medical therapy with high-dose IVIG and rituximab has been proposed as an alternative to serial TPE treatments for patients awaiting deceased donor renal transplantation [11,12].…”