HLA desensitization based on results of the luminex technique in kidney transplant – A single-center experience

Background: There is little experience of human leucocyte antigen (HLA) desensitization in India based on the Luminex single-antigen bead (SAB) testing. We retrospectively analyzed our patients, who underwent HLA desensitization based on Luminex SAB results. Method: Between 2014 and 2018, patients w...

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Autores principales:	S B Bansal, A Gade, S Sinha, A Mahapatra, P Jha, S K Sethi
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer Medknow Publications 2021
Materias:	hla desensitization kidney living donor luminex Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/ead2e3eab5f0420ba7a226f9ef936ad9
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spelling	oai:doaj.org-article:ead2e3eab5f0420ba7a226f9ef936ad92021-12-02T17:49:11ZHLA desensitization based on results of the luminex technique in kidney transplant – A single-center experience0971-40651998-366210.4103/ijn.IJN_237_20https://doaj.org/article/ead2e3eab5f0420ba7a226f9ef936ad92021-01-01T00:00:00Zhttp://www.indianjnephrol.org/article.asp?issn=0971-4065;year=2021;volume=31;issue=5;spage=454;epage=459;aulast=Bansalhttps://doaj.org/toc/0971-4065https://doaj.org/toc/1998-3662Background: There is little experience of human leucocyte antigen (HLA) desensitization in India based on the Luminex single-antigen bead (SAB) testing. We retrospectively analyzed our patients, who underwent HLA desensitization based on Luminex SAB results. Method: Between 2014 and 2018, patients with complement-dependent cytotoxicity cross-match (CDC-XM) negativity but flow cytometry crossmatch (FC-XM) positivity were further analyzed with Luminex SAB for donor-specific antibodies (DSAs). A total of 12 patients who had DSA mean fluorescent intensity (MFI) of >1000 and <10,000 were included in the study. Our protocol for desensitization consisted of plasmapheresis (PP) followed by low dose intravenous immunoglobulin (IV IG) 100 mg/kg and induction with antithymocyte globulin (ATG). Patients were taken for transplant when either MFI was <1000 and/or FC-XM was negative. Results: All 12 patients were first transplant and 10 had a history of some sensitizing event; pregnancy in 4, blood transfusions in 4, and both in 2 patients. FC-XM was positive for T-cell in 4, B-cell in 6, and both in 2 patients. On evaluation by Luminex SAB, 6 patients had MFI from 1000 to 2000, and 6 had MFI of >2000. All underwent desensitization successfully. Two patients had an increase in posttransplant DSA titers requiring posttransplant PP. The mean follow-up was 26.6 ± 13.9 months. On follow-up, only one patient developed acute T cell-mediated rejection 1 year after transplant, which responded to pulse steroids. There was no graft or patient loss until the last follow-up. Conclusion: This study shows that HLA desensitization is feasible and successful in the Indian setting if patients are properly selected.S B BansalA GadeS SinhaA MahapatraP JhaS K SethiWolters Kluwer Medknow Publicationsarticlehla desensitizationkidneyliving donorluminexDiseases of the genitourinary system. UrologyRC870-923ENIndian Journal of Nephrology, Vol 31, Iss 5, Pp 454-459 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	hla desensitization kidney living donor luminex Diseases of the genitourinary system. Urology RC870-923
spellingShingle	hla desensitization kidney living donor luminex Diseases of the genitourinary system. Urology RC870-923 S B Bansal A Gade S Sinha A Mahapatra P Jha S K Sethi HLA desensitization based on results of the luminex technique in kidney transplant – A single-center experience
description	Background: There is little experience of human leucocyte antigen (HLA) desensitization in India based on the Luminex single-antigen bead (SAB) testing. We retrospectively analyzed our patients, who underwent HLA desensitization based on Luminex SAB results. Method: Between 2014 and 2018, patients with complement-dependent cytotoxicity cross-match (CDC-XM) negativity but flow cytometry crossmatch (FC-XM) positivity were further analyzed with Luminex SAB for donor-specific antibodies (DSAs). A total of 12 patients who had DSA mean fluorescent intensity (MFI) of >1000 and <10,000 were included in the study. Our protocol for desensitization consisted of plasmapheresis (PP) followed by low dose intravenous immunoglobulin (IV IG) 100 mg/kg and induction with antithymocyte globulin (ATG). Patients were taken for transplant when either MFI was <1000 and/or FC-XM was negative. Results: All 12 patients were first transplant and 10 had a history of some sensitizing event; pregnancy in 4, blood transfusions in 4, and both in 2 patients. FC-XM was positive for T-cell in 4, B-cell in 6, and both in 2 patients. On evaluation by Luminex SAB, 6 patients had MFI from 1000 to 2000, and 6 had MFI of >2000. All underwent desensitization successfully. Two patients had an increase in posttransplant DSA titers requiring posttransplant PP. The mean follow-up was 26.6 ± 13.9 months. On follow-up, only one patient developed acute T cell-mediated rejection 1 year after transplant, which responded to pulse steroids. There was no graft or patient loss until the last follow-up. Conclusion: This study shows that HLA desensitization is feasible and successful in the Indian setting if patients are properly selected.
format	article
author	S B Bansal A Gade S Sinha A Mahapatra P Jha S K Sethi
author_facet	S B Bansal A Gade S Sinha A Mahapatra P Jha S K Sethi
author_sort	S B Bansal
title	HLA desensitization based on results of the luminex technique in kidney transplant – A single-center experience
title_short	HLA desensitization based on results of the luminex technique in kidney transplant – A single-center experience
title_full	HLA desensitization based on results of the luminex technique in kidney transplant – A single-center experience
title_fullStr	HLA desensitization based on results of the luminex technique in kidney transplant – A single-center experience
title_full_unstemmed	HLA desensitization based on results of the luminex technique in kidney transplant – A single-center experience
title_sort	hla desensitization based on results of the luminex technique in kidney transplant – a single-center experience
publisher	Wolters Kluwer Medknow Publications
publishDate	2021
url	https://doaj.org/article/ead2e3eab5f0420ba7a226f9ef936ad9
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HLA desensitization based on results of the luminex technique in kidney transplant – A single-center experience

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