الفهرس 
The impact of pre-transplant donor-specific anti-hla antibodies despite a negative cdc cross match on the outcomes of kidney transplantation
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Abstract
Background: Pre-formed antibodies directed against human leukocyte antigens (HLA) have a major impact on allograft survival and form a significant barrier in renal transplantation. The clinical significance of pre-transplant donor specific antibodies (DSA) despite negative cytotoxic cross match (CDC-XM) would be useful for clinical decision making. We aimed to determine the impact of pre-transplant DSA despite a negative CDC-XM on the outcome of kidney transplantation. Methods: One hundred and eleven patients were prospectively recruited for renal transplantation at Hamed Al-Essa organ transplant center in Kuwait between January 2011 and December 2013. Patients were divided into 2 groups, first group included 50 recipients with positive DSA at the time of transplant and were subjected to desensitization protocol. Three local protocols were utilized; first protocol: Plasma exchange, high dose intravenous immunoglobulin (H-IVIG), and Rituximab (RTX); second protocol: Immunoadsorption plus RTX, and third Protocol: H-IVIG and RTX. The second group included 61 recipients with negative DSA at the time of transplant (the control group). All recipients had negative CDC-XM and flow-cytometry cross-match (FCXM) at the time of transplant. Mean florescence intensity (MFI) was considered positive {u2265} 1500. Serum creatinine, proteinuria, PRA and DSA levels were carried out basal and at 3, 6, 12, 24 months after transplantation for all patients. Results: The mean PRA positivity for both classes I and II anti HLA antibodies at base line and during follow up to 24 months were statistically significant difference P {u02C2} 0.05. There was no statistical significant difference regarding early post-transplant graft function, patient survival, and graft survivals between the two groups. Conclusion: Renal transplantation outcomes after successful desensitization was comparable to low immunological risk transplantation for both graft and patient survival