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Resource Center | Transplant Journal Abstracts

Efficacy, Outcomes, and Cost-Effectiveness of Desensitization Using IVIG and RituximabMarch 22, 2013

Authors:
Vo, Ashley A.1,6; Petrozzino, Jeffrey2,3; Yeung, Kai1; Sinha, Aditi4; Kahwaji, Joseph1; Peng, Alice1; Villicana, Rafael1; Mackowiak, John5; Jordan, Stanley C.1

 

Reference:
Transplantation. 2013 Mar;95(6):852-858
doi: 10.1097/TP.0b013e3182802f88

 

Abstract:
Background: Transplantation rates are very low for the broadly sensitized patient (panel reactive antibody [PRA]>80%; HS). Here, we examine the efficacy, outcomes, and cost-effectiveness of desensitization using high-dose intravenous immunoglobulin (IVIG) and rituximab to improve transplantation rates in HS patients.

 

Methods: From July 2006 to December 2011, 207 HS (56 living donors/151 deceased donors) patients (donor-specific antibody positive, PRA>80%) were desensitized using IVIG and rituximab. After desensitization, responsive patients proceeded to transplantation with an acceptable crossmatch. Cost and outcomes of desensitization were compared with dialysis.

 

Results: Of the 207 treated patients, 146 (71%) were transplanted. At 48 months, patient and graft survival by Kaplan–Meier were 95% and 87.5%, respectively. The total 3-year cost for patients treated in the desensitization arm was $219,914 per patient compared with $238,667 per patient treated in the dialysis arm. Thus, each patient treated with desensitization is estimated to save the U.S. healthcare system $18,753 in 2011 USD. Overall, estimated patient survival at the end of 3 years was 96.6% for patients in the desensitization arm of the model (based on Cedars-Sinai survival rate) compared with 79.0% for an age, end-stage renal disease etiology, and PRA matched group of patients remaining on dialysis during the study period.

 

Conclusions: We conclude that desensitization with IVIG+rituximab is clinically and cost-effective, with both financial savings and an estimated 17.6% greater probability of 3-year survival associated with desensitization versus dialysis alone. However, the benefits of desensitization and transplantation are limited by organ availability and allocation policies.

© 2013 Lippincott Williams & Wilkins, Inc.

Desensitization combined with paired exchange leads to successful transplantation in highly sensitized kidney transplant recipients: strategy and report of five cases.March 21, 2013

Authors:
Yabu JM, Pando MJ, Busque S, Melcher ML.

 

Reference:
Transplant Proc. 2013 Jan-Feb;45(1):82-7.
doi: 10.1016/j.transproceed.2012.08.007.

 

Source:
Division of Nephrology, Department of Medicine, Stanford University, CA, USA. jyabu@stanford.edu

 

Abstract:
Sensitization remains a major barrier to kidney transplantation. Sensitized patients comprise 30% of the kidney transplant waiting list but fewer than 15% of highly sensitized patients are transplanted each year. Options for highly sensitized patients with an immunologically incompatible living donor include desensitization or kidney paired donation (KPD). However, these options when used alone may still not be sufficient to allow a compatible transplant for recipients who are broadly sensitized with cumulative calculated panel-reactive antibody (cPRA) > 95%. We describe in this report the combined use of both desensitization and KPD to maximize the likelihood of finding a compatible match with a more immunologically favorable donor through a kidney exchange program. This combined approach was used in five very highly sensitized patients, all with cPRA 100%, who ultimately received compatible living and deceased donor kidney transplants. We conclude that early enrollment in paired kidney donor exchange and tailored desensitization protocols are key strategies to improve care and rates of kidney transplantation in highly sensitized patients.

 

Copyright © 2013 Elsevier Inc. All rights reserved.

 

PMID:  23375278

 

[PubMed - in process]

 

PMCID:  PMC3564056

 

[Available on 2014/1/1]