Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.transproceed.2011.12.046
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dc.titleSuccessful transplantation across positive B-cell cross-match in deceased donor renal transplants
dc.contributor.authorGoh, A
dc.contributor.authorOei, E
dc.contributor.authorVathsala, A
dc.date.accessioned2022-08-01T09:13:31Z
dc.date.available2022-08-01T09:13:31Z
dc.date.issued2012-01-01
dc.identifier.citationGoh, A, Oei, E, Vathsala, A (2012-01-01). Successful transplantation across positive B-cell cross-match in deceased donor renal transplants. Transplantation Proceedings 44 (1) : 193-199. ScholarBank@NUS Repository. https://doi.org/10.1016/j.transproceed.2011.12.046
dc.identifier.issn00411345
dc.identifier.issn18732623
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/229680
dc.description.abstractA positive T-cell cross-match is a well-established contraindication to deceased donor renal transplantation (DDRT); however, the significance of a positive B-cell cross-match (BCXM) remains debatable. Thus, given the high demand and scarce supply for deceased donor (DD) kidneys, only T- and B-cell cytotoxic cross-matchnegative recipients were considered for DDRT in the past at our institution. Since September 2007, we have started performing DDRT across a historical positive cytotoxic BCXM. When a matched DD kidney became available, patients who were BCXM-positive (BCXM+) on historical sera would undergo repeat cross-match with current sera, using enhanced techniques. BCXM+ and current T-cell immunoglobulin (Ig)G cross-matchnegative patients underwent transplantation with enhanced immunosuppression. Donor-specific anti-HLA antibodies (DSA) were tested for only in BCXM+ patients. The present study was designed to review outcomes of historical BCXM+ versus BCXM-negative (BCXM-) DDRT. Between September 2007 and October 2009, 11 BCXM+ and 50 BCXM- DDRT were performed. All patients were followed-up till October 31, 2010. Demographics and sensitization history of both groups were comparable. DSA were present in 6 (54.5%) BCXM+ patients, irrespective of their current cross-match status. All BCXM+ patients received induction immunosuppression with anti-thymocyte globulin, whereas only 60% of BCXM- patients had induction therapy. All BCXM+ patients and the majority of BCXM- patients received a calcineurin inhibitorbased maintenance regimen. DSA-positive patients received several sessions of plasmapheresis, followed by cytomegalovirus (CMV) hyperimmune globulin after every session. Graft and patient survivals were similar at 12 and 24 months in both groups. Their incidence of BK viremia, CMV antigenemia, and early acute rejection was also similar. The presence of DSA did not increase the risk for acute rejection. Performing DDRT across a positive BCXM with enhanced immunosuppression has enabled highly sensitized patients to receive a transplant with noninferior short-term outcomes compared with lowimmunologic risk patients. © 2012 Published by Elsevier Inc.
dc.publisherElsevier BV
dc.sourceElements
dc.subjectAdult
dc.subjectB-Lymphocytes
dc.subjectBK Virus
dc.subjectChi-Square Distribution
dc.subjectCytomegalovirus Infections
dc.subjectCytotoxicity Tests, Immunologic
dc.subjectDelayed Graft Function
dc.subjectFemale
dc.subjectGraft Rejection
dc.subjectGraft Survival
dc.subjectHLA Antigens
dc.subjectHistocompatibility
dc.subjectHistocompatibility Testing
dc.subjectHumans
dc.subjectImmunosuppressive Agents
dc.subjectIsoantibodies
dc.subjectKidney Transplantation
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectPolyomavirus Infections
dc.subjectRetrospective Studies
dc.subjectRisk Assessment
dc.subjectRisk Factors
dc.subjectSingapore
dc.subjectSurvival Analysis
dc.subjectTime Factors
dc.subjectTreatment Outcome
dc.typeArticle
dc.date.updated2022-07-24T02:52:27Z
dc.contributor.departmentMEDICINE
dc.description.doi10.1016/j.transproceed.2011.12.046
dc.description.sourcetitleTransplantation Proceedings
dc.description.volume44
dc.description.issue1
dc.description.page193-199
dc.description.placeUnited States
dc.published.statePublished
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