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KMID : 0361120020160020172
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Korean Journal of Transplantation
2002 Volume.16 No. 2 p.172 ~ p.177
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The Results of Renal Transplantation after Lymphocyte Cross-match Negative Conversion by Combination Therapy with Plasmapheresis, Intravenous Gamma Globulin and Potent Immunosuppresants in Patients with Positive LCM
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권기환/Ki Hwan Kwon
문장일/장한정/김봉수/최규헌/강신욱/한대석/홍성준/양승철/이웅희/김현옥/김순일/김유선/박기일/Jang Il Moon/Han Jeong Chang/Bong Soo Kim/Kyu Hyun Choi/Shin Wook Kang/Dae Suk Han/Sung Joon Hong/Seong Chul Yang/Woong Hee Lee/Hyun Ok Kim/Soon Il Kim/Yu Seun Kim/
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Abstract
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Purpose: It is well-known that kidney transplantation cannot be done if recipient has circulating antibodies showing positive lymphocyte cross-match (LCX) to organ donor. In the United States and European countries, the incidence of
positive
LCX
to cadaveric donors in patients who are on the waiting list is up to 20∼40%. Unfortunately, these patients also show high rate of positive LCX to live donors when they have donor candidates in their family members and have to be on dialysis
until
compatible donor comes up. Recently, Eugene J Schweitzer and his associates at the University of Maryland used the combination therapy with plasmapheresis, intravenous gamma globulin and potent immunosuppression to induce negative conversion of
LCX
in
patients who were LCX positive to their living donors and reported the good results after the trial. We did the combination therapy in patients who had positive LCX to their living donors and reported the results.
Methods: Seven patients, four women and three men who showed positive LCX to their living donors, underwent the conversion trials between January 1 and July 31, 2002. The mean age of patients was 43.86 (35∼60) and the duration of dialyses
varies
from 9 to 120 months. We used combination therapy with plasmapheresis, intravenous gamma globulin injection, tacrolimus, mycophenolate mofetil (MMF) and steroids. Plasmapheresis had been done on every other day up to 6 times to induce negative
conversion of LCX. If patient continue to show positive LCX to donor after 6 times of plasmapheresis, we stopped the therapy. The numbers of plasmapheresis varies from two to six times. Kidney transplantations were preformed immediately after
negative
conversion of LCX as a semi-elective procedures. Five to ten day courses of ATG (or OKT3) were used as an induction immunosuppression after transplantation and tacrolimus, MMF, and steroids were used as a maintenance immunosuppression.
Results: We could achieve negative conversion of LCX in six out of seven patients, and kidney transplantations were performed in these 6 patients successfully. There was no hyperacute rejection during the operations, but three patients
developed
acute rejection episodes during their early postoperative periods. Steroid pulse therapies were used as a primary therapy to treat acute rejection and all three patients showed complete recovery of their graft function after the treatments.
Baseline
serum creatinine level varies from 1.0 ㎎/㎗ to 1.9 ㎎/㎗ with 3 to 6 months follow-up periods after transplantations. We could not induce negative conversion in one patient and he remained on hemodialysis.
Conclusion: We did successful kidney transplantations in six patients who achieved negative conversion of LCX to their donors after the combination therapy with plasmapheresis and potent immunosuppression. All patients showed excellent
graft
function since their operations and did not have any significant complications except three reversible acute rejection episodes. According to the results, although it is preliminary, we recommend the use of the combination therapy in patient who
has LCX
positive living donor. Further long-term study with more numbers of patients is needed for the evaluation of the efficacy of this trial.
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KEYWORD
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