التفاصيل البيبلوغرافية
| العنوان: |
Successful Deceased Donor Kidney Transplantation in a Highly Sensitized Patient after Reclassification of Unacceptable Antigens Based on HLA Epitope Analysis |
| المؤلفون: |
Alferes,Daniela, Tafulo,Sandra, Tavares,Isabel, Nunes,Ana Teresa, Rocha,Ana, Bustorff,Manuela, Sampaio,Susana |
| بيانات النشر: |
Sociedade Portuguesa de Nefrologia, 2022. |
| سنة النشر: |
2022 |
| مصطلحات موضوعية: |
Graft Survival, HLA Antigens/immunology Histocompatibility Testing, Kidney Transplantation/immunology |
| الوصف: |
For patients with end stage renal disease, kidney transplant offers significant survival and quality-of-life advantages compared with dialysis. But for patients seeking transplant who are highly sensitized, waiting times have traditionally been long and options limited. We present the case of a 34-year-old hypersensitized female who underwent renal retransplantation. Histocompatibility tests revealed a calculated panel-reactive antibody of 99.53% with multiple antibodies against class I and II human leucocyte antigens and an eplet analysis was performed. The donor’s potential unacceptable antigens were re-defined and the calculated panel-reactive antibody decreased to 88.38%. After one month the patient received a deceased-donor kidney transplant. Complement dependent cytotoxicity crossmatch was negative; virtual crossmatch and flow cytometry crossmatch with historical serum were positive. High-dose intravenous immunoglobulin and rituximab were added to the thymoglobulin-based induction immunosuppression. Three donor-specific antibodies were detected and plasmapheresis was performed. Renal allograft biopsy revealed no manifestations of rejection. Repeated testing observed a decrease in donor-specific antibodies median fluorescence intensity values. Four months post-transplant, the patient remained with normal graft function without proteinuria. She is receiving a standard maintenance immunosuppression regime with prednisolone, mycophenolate mofetil and tacrolimus. The careful discussion among the transplantation center and histocompatibility laboratory in association with intense immunosuppression and close laboratory monitoring allowed a successful human leukocyte antigen-incompatible deceased donor kidney transplantation in the most critical phase for the occurrence of humoral rejection. It is noteworthy that the new histocompatibility and immunogenetics methodologies provide a more affirmative and comprehensive assessment of mismatch acceptability. |
| نوع الوثيقة: |
Report |
| وصف الملف: |
text/html |
| اللغة: |
English |
| العلاقة: |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400254Test |
| الإتاحة: |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400254Test |
| حقوق: |
open access |
| رقم الانضمام: |
rcaap.com.SciELO.scielo.S0872.01692022000400254 |
| قاعدة البيانات: |
RCAAP |
