Desensitization for Kidney Transplant
Some patients who are candidates for kidney transplantation are highly sensitized. A highly sensitized patient is someone whose immune system has many antibodies to fight against other people’s cells. (More technically speaking, a "highly sensitized" patient is defined as someone whose panel of reactive antibodies, or PRA, is 80 percent or higher.)
In the United States, about 16 percent of patients on the kidney transplant list are highly sensitized. For these patients, preformed antibodies will react with a transplanted kidney and cause hyperacute rejection – which can lead to transplant loss in minutes or even before the surgery is finished.
At the Jefferson Kidney Transplant Program, we evaluate the risk of hyperacute rejection with the crossmatch that is performed before each transplant. A highly sensitized patient will frequently have a positive crossmatch, which will preclude transplantation and often leads to a longer waiting time on the transplant list.
To help these patients receive a transplant sooner, we have a treatment protocol to decrease antibody titers. If you are highly sensitized, we will treat you with rituximab and intravenous immunoglobulin (IVIG) as part of our desensitization protocol. The first step would entail making sure that all your annual updates and testing is in order. To be considered for this protocol, you must have at least five years of waiting time on the list and no availability of living donors.
At Jefferson, we rigorously educate patients about all the possible side effects of the medications involved. For many patients, the risks are outweighed by the potential benefits of having a reasonable shot at transplantation, getting off dialysis therapy and, ultimately, improving quality of life and longevity.