Therapeutic options and efficacy analysis of sensitized renal transplant recipients

Objective To investigate the therapeutic options and effect of sensitized renal transplant recipients.Method Forty-three sensitized renal transplant patients in our hospital from 2008 to 2011 were enrolled in this study,and divided into mild sensitized group and highly sensitized group according to preoperative panel reactive antibody (PRA) levels.Therapeutic options included preoperative plasmapheresis,infusion of intravenous immunoglobulin (IVIG),HLA typing,the application of anti-human thymocyte immune globulin (ATG) induction therapy,application of tacrolimus,mycophenolate mofetil,and prednisone immunosuppressive regimen.During the follow-up period of 12 to 36 months for all patients,patient/graft survival,incidence of acute rejection,renal function,PRA levels and transplant renal biopsy pathological changes were observed.Result After the intervention therapy,PRA level of 14 cases in mild sensitized group and 5 in highly sensitized group completely became negative,and that of the remaining patients was significantly decreased (P＜0.05) as compared with that before intervention.PRA levels in both groups were significantly increased after kidney transplantation.In mild sensitized group and highly sensitized group,survival rate of patients was 95.6％ and 90％,and graft survival rate was 82.6％ and 70％,respectively.Acute cellular rejection was confirmed by renal allograft biopsy in 3 cases in mild sensitized group,and 5 cases in highly sensitized group.Acute cellular rejections were reversed by methylprednisolone therapy for 3 to 5 days.Ten patients with slowly climbing serum creatinine in both groups underwent renal allograft biopsy showing chronic allograft nephropathy.Conclusion Plasmapheresis,infusion IVIG,good HLA matching,ATG induction therapy,tacrolimus,mycophenolate mofetil,and prednisone immunosuppressive regimen were prerequisite for success kidney transplantation in sensitized patients. Key words: Sensitized;  Kidney transplantation;  Therapeutic options;  Efficacy