AMR: Antibody Mediated Rejection; BSHI:
British Society for Histocompatibility and Immunogenetics; CDCXM: CDC Cross-Match;
CREG: Cross Reactive Group; DSA: Donor Specific Antibody; FCXM: Flowcytometry
Cross-Match; HLA: Human Leukocyte antigen; HLAi: HLA incompatible; IVIg: Intra
Venous Immuno globulin; KSS: UK Living Donor Kidney Sharing Scheme; MFI: Mean
Fluorescence Intensity; MMF: Mycophenolate Mofetil μ mol/L: Micromoles/litre;
PRA: Panel Reactive Antibody; POD: Post Operative Day; SAB: Single Antigen Bead.
HLA Incompatible (HLAI) renal
transplantation with desensitization is being increasingly performed in
Northern Ireland because it results in better quality of life and improved
survival compared to long term maintenance dialysis. Risk stratification for
potential recipients in the United Kingdom is performed according to British
Society of Histocompatibility and Immunogenetics (BSHI) / British Transplant
Society (BTS) guidelines, which involves comprehensive evaluation by a
combination of Complement Dependent Cytotoxicity Cross-Match (CDCXM),
Flowcytometry Cross-Match (FCXM) and Luminex Single Antigen Bead (SAB) assay,
and correlation with sensitization history. Transplanting successfully across a
broad specificity such as HLA- Bw4 or Bw6 may prove more difficult, because
non–DSA reacting with Bw4 or Bw6 epitopes could have an additive effect and
hence greater overall reactivity even if reactivity against the donor
mismatched allele is low. In this paper the workup leading to successful
outcome of two HLAI transplants performed in Belfast City Hospital is
presented. Maintenance immunosuppression was with the triple drug regimen of
Prednisolone, Mycophenolate Mofetil (MMF) and Tacrolimus.
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