Kidney transplantation in highly sensitized patient

Introduction: Patients with end stage renal disease after blood transfusion, during pregnancy and organ transplantation develop high titer antibodies to Human Leukocyte Antigen (HLA) system which have until recently represented contraindication for transplantation. Recently developed desensitization protocol reduces the level of antibodies and allows successful transplantation and retransplantation. Methods: Application of desensitization protocol wich includes a specific immunological compatibility, negative cross-match, plasmapheresis before, during and after transplantation, administration intravenous immunoglobulins (IVIG) after each plasmapheresis and one-time application of monoclonal antibody (Rituximab). Case report: The patient, 48 years old, becouse of end stage renal disease has been on chronic hemodialysis for one year. His primary kidney disease was chronic glomerulonephritis. In September 1999 his first kidney transplantation (LRD) was made in Austria., the kidney donor was his sister and graft was 7 years functional. In October 2008 the graft nephrectomy was done. Becouse of previous transplantation the patient developed high sensitization (Anti-HLA antibody titre). In December 2009 kidney retransplantation has been done with desensitization protocol. This time the kidney donor was his brother, with whom the patient had an identical blood group and complete an identical tissue match. In the postoperative period, two surgical complications have been appeared: bleeding from the operative field and wound infection. After 1 month he dissmissed recovered, with normal parameters of renal function and negative parameters of inflammation. Conclusion: With application of desensitization protocol successful transplantation and retransplantation can be performed.