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Renal transplantation in sensitized children and young adults: a nationwide approach
- Source :
- Nephrology, dialysis, transplantation, 32 (2017): 191–195. doi:10.1093/ndt/gfw369, info:cnr-pdr/source/autori:Dello Strologo L.D.; Murer L.; Guzzo I.; Morolli F.; Pipicelli A.M.V.; Benetti E.; Longo G.; Testa S.; Ricci A.; Ginevri F.; Ghio L.; Cardillo M.; Piazza A.; Costa A.N./titolo:Renal transplantation in sensitized children and young adults: A nationwide approach/doi:10.1093%2Fndt%2Fgfw369/rivista:Nephrology, dialysis, transplantation (Print)/anno:2017/pagina_da:191/pagina_a:195/intervallo_pagine:191–195/volume:32
- Publication Year :
- 2016
-
Abstract
- Background. High levels of preformed anti-HLA antibodies dramatically diminish renal transplant outcomes.Most desensitization programmes guarantee good intermediate outcomes but quite disappointing long-term prognosis. The search for a fully compatible kidney increases time on the waiting list. Methods. In February 2011, a nationwide hyperimmune programme (NHP) was begun in Italy: all available kidneys are primarily proposed to highly sensitized patients with a panel reactive antibody above 80%. In this manuscript, we evaluate the outcome of paediatric patients transplanted with this approach. Results. Twenty-one patients were transplanted. Complete data are available for 20 patients. Mean age at transplantation was 14.5 years [standard deviation (SD) 6 5.5)]. Mean time on the waiting list was 29.3 months (SD 6 27.5). Median follow-up was 29.2 months (range: 11.2-59.3). The average number of HLA mismatches in these patients was 2.3 versus 3.7 in 48 standard patients transplanted in the same period (P < 0.001). Only one graft was lost. Two cases of humoral rejection occurred and were successfully treated. No cellular rejection was reported. Median creatinine clearance was 84, 88, 77 and 77 mL/min/1.73 m2 respectively 1, 6, 12 and 24 months after transplant. Conclusions. Transplantation of sensitized patients avoiding prohibited antigens is feasible, at least in a selected cohort of patients. In order to be able to further improve this approach, which in our opinion is very successful, it would be necessary to expand the donor pool, possibly increasing the number of countries participating in the programme. In this series, time on the waiting list did not increase significantly. This allocation policy should ideally lead to an outcome comparable to that expected in standard patients, which is particularly desirable in young patients who have the longest life expectancy. Since long-term results of desensitization programmes are not (yet) convincing, we suggest that these programmes should be reserved for selected cases where compatible organs cannot be found within a reasonable time span.
- Subjects :
- Adult
Male
Pediatrics
medicine.medical_specialty
Adolescent
030232 urology & nephrology
Renal function
030230 surgery
allocation policy
paediatric
renal transplant
sensitization
Isoantibodies
03 medical and health sciences
Young Adult
0302 clinical medicine
HLA Antigens
medicine
Humans
Young adult
Child
Kidney transplantation
Transplantation
business.industry
Histocompatibility Testing
Graft Survival
Panel reactive antibody
medicine.disease
Kidney Transplantation
Nephrology
Desensitization, Immunologic
Child, Preschool
Immunology
Cohort
Kidney Failure, Chronic
Female
business
Cohort study
Subjects
Details
- ISSN :
- 14602385
- Volume :
- 32
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
- Accession number :
- edsair.doi.dedup.....be2f278d9f1a860aa90b9b475f7f2163