The Result of Renal Allograft which Lymphocyte Crossmatch is Negatively Converted by Pretransplant Plasmapheresis and 4 γ-globulin

Purpose: Many patients who have an acceptable living-kidney donor do not undergo transplantation because of the presence of antibodies against the donor cells resulting in a positive lymphocyte-crossmatch (LCX). Recently, the combination therapy of plasmapheresis, intravenous gamma-globulin and potent immunosuppression to induce negative conversion of LCX in patients who had positive LCX to their living donors was reported. Our institute gave these patients the combination therapy and reported the results of follow-up done 1~3 years after kidney transplantation. Methods: Eleven patients, who showed positive LCX to their living donors, underwent the conversion trials between January 1, 2002 and March 31, 2004. Combination therapy consisting of plasmapheresis, intravenous gamma globulin injection, tacrolimus, mycophenolate mofetil (MMF) and steroids was used. Plasmapheresis had been done every other day up to 6 times. Kidney transplantations were performed immediately after negative conversion was achieved. Five to ten day-courses of ATG (or OKT3) were used as an induction immunosuppression and tacrolimus, MMF, and steroids as a maintenance immunosuppression. Results: Negative conversions in ten out of eleven patients were achieved. Kidney transplantations in these 10 patients were successfully performed. No hyperacute rejection transpired, although four patients developed acute rejection, whose grafts were all rescued with steroid pulse therapy. Serum creatinine level was 1.57±0.12 ㎎/㎗ (mean±SD) during follow-up periods except for one whose graft was lost to Polyoma virus nephropathy. Conclusion: Nine of the 10 grafts are functioning well for 15~41 months after transplantations. Our results suggest that selected crossmatch positive patients can be transplanted successfully with living donor kidney allograft.ope