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CASE SERIES
Year : 2020  |  Volume : 14  |  Issue : 2  |  Page : 175-181

Role of donor-specific antibodies in immunological assessment for kidney transplant: A report of ten cases in a cost-limited set-up


1 Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
4 Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Dr. Raja Ramachandran
Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_45_19

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Sensitized patients, who constitute a considerable proportion of kidney-transplant recipients, often have poor allograft outcomes. Only cell-based complement-dependent cytotoxicity (CDC) assays are typically used to quantify donor-specific antibodies (DSAs) in patients in developing nations, owing to financial restraints. We report the clinical outcomes of ten sensitized patients who were stratified and managed based on Luminex single-antigen beads (SAB) method for the DSA detection in a cost-limited set-up. Sensitization events included a history of blood transfusion, multiple pregnancies, and previous allograft loss. Anti-human leukocyte antigen antibodies, measured by SAB and reported as mean fluorescence intensity (MFI), were considered positive if the value was > 1000 MFI for single antigen. Three best approaches, (1) cadaveric transplants using virtual cross-match for kidney allocation in five patients, (2) desensitization before living donor transplants for four donor–recipient pairs with immunological incompatibility (high DSAs but cross-match compatible), and (3) combined kidney paired exchange with desensitization for one donor–recipient pair with cross-match incompatibility (positive CDC cross-match), resulted in successful allograft outcomes in all the 10 patients during follow-up (range: 3–55 months). DSA by SAB to assess pretransplant immunological risk (in a sensitized recipient) is useful even in cost-limited settings, largely due to reduction of posttransplant rejection rates and avoidance of mortality while on the waitlist.


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