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Intravenous immunoglobulin, HLA allele typing and
HLAMatchmaker facilitate successful transplantation in highly
sensitized pediatric renal allograft recipients.
Pediatr Transplant. 2007 Feb;11(1):77-81.
Valentini RP, Nehlsen-Cannarella SL, Gruber SA, Mattoo TK, West MS, Lang C, Imam AA.
Division
of Nephrology, The Carman and Ann Adams Department of Pediatrics, Wayne
State University School of Medicine, Children's Hospital of Michigan,
Detroit, MI, USA.
The use of intravenous immunoglobulin (IVIG)
in sensitized transplant candidates has resulted in reduced HLA
antibody levels and shorter transplant wait times. In addition, the
HLAMatchmaker program has been used to identify acceptable mismatches
to permit transplantation in highly sensitized patients.
We used IVIG
desensitization in conjunction with high resolution HLA allele typing
and HLAMatchmaker grading of donor offers to facilitate successful
transplantation in two highly sensitized children who were awaiting
second renal transplants. Both patients lost their initial transplant
in <10 days to accelerated acute rejection, and were on dialysis for
an average of 50 months with high panel reactive antibody (PRA) levels.
They were started on monthly IVIG infusions (2 g/kg/dose). Within one
wk following their third and fifth IVIG doses, both patients received a
crossmatch compatible, deceased donor renal transplant selected by
HLAMatchmaker as a suitable donor offer. Both patients remain rejection
free with excellent renal function 19 and 15 months post-transplant,
respectively. In conclusion, combining IVIG therapy and donor selection
by HLA humoral epitope matching permitted successful transplantation of
two highly sensitized children. Further studies in larger numbers of
patients with longer follow-up are needed to determine the individual
role played by, and relative importance of each component of this
combined strategy.
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