HLAIncompatible (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.
ESRDdue to antineutrophil cytoplasmic antibody positive vasculitis, for which
peritoneal dialysis was commenced in June 2014. Both HLA -class I and II IgG
antibodies including HLA- B35, B60, B71, B75, DPB11, DR103 and DR7 were as
defined unacceptable on SAB assay. The T and B cell IgG Calculated Reaction
Frequency (CRF) were 30% and 54% respectively. Her husband was considered
suitable as a potential living donor but tested FCXM positive and she had high
DSA against his mismatched antigens.
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