Efficacy and Safety of a Desensitization Treatment With Rituximab and Immunoglobulin in Hyperimmunized Patients Awaiting a Cadaveric Kidney Transplantation

Background. Patients on a kidney transplant waiting list with antibodies against more than 80% of a panel reactive antibody (PRA) are difficult to transplant, even with national or regional programs. Desensitization treatment with high-dose intravenous immunoglobulin and rituximab could be offered to patients with a long waiting time for a cadaveric donor to improve their odds of finding a kidney. Methods. This was a retrospective, single-center study including all hyperimmunized patients on the waiting list for a cadaveric kidney donor who received a desensitization treatment between 2010 and 2020. Eight patients (50% male patients, mean age = 41.5 +/- 16.4 years) were desensitized with intravenous immunoglobulin and rituximab. Seventy-five percent of the patients had received a previous transplant. The median PRA calculated was 98%. The mean follow-up time after transplantation was 67 months. Results. No patient presented significant side effects to desensitization treatment. Seven of the 8 patients (87.5%) received a transplant from a cadaveric donor, in a median 8 months after desensitization. In the immediate post-transplant period, there were two graft losses (28.6%) due to non-immunological causes (1 venous thrombosis in a patient with a coagulation disorder and 1 primary graft failure). Creatinine levels at 1 and 5 years were 1.4 +/- 0.2 mg/dL and 1.7 +/- 0.6 mg/dL, respectively. There were no episodes of acute rejection. No patient developed cancer during the follow-up. Conclusions. Desensitization treatment with immunoglobulin and rituximab on hyperimmunized patients on the cadaveric transplant waiting list is a safe and effective treatment that increases the chances of achieving a kidney transplant in highly sensitized patients.