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Low-risk delisting strategy in highly sensitized patients without donor offers included in exchange donation programs. One single-center experience

Abstract: Donor exchange programs were designed to allocate organs for highly sensitized (HS) patients. The allocation algorithm differs slightly among countries and includes different strategies to improve access to transplants in HS patients. However, many HS patients with a calculated panel reactive of antibodies (cPRA) of 100 % remain on the waiting list for a long time. Some allocation algorithms assume immunological risk, including Imlifidase treatment, to increase the chance of transplantation in very HS patients. Here, we describe our unicenter experience of low-risk delisting strategy in 15 HS patients included in the Spanish donor exchange program without donor offers. After delisting, 7 out of 15 HS patients reduced the cPRA below 99.95 % and impacted the reduction of time on the waiting list (p = 0.01), where 5 out of 7 achieved transplantation. Within those HS that remained above 99.95 %, 1 out of 8 was transplanted. All the HS were transplanted with delisted DSA, and only one with DSA level rebounded early after transplantation. All HS transplanted after delisting maintain graft function. The transplant immunology laboratories are challenged to search intermediate risk assessment methods for delisting high HS patients.

 Fuente: Human Immunology, 2024, 85(3), 110806

 Editorial: Elsevier

 Año de publicación: 2024

 Nº de páginas: 9

 Tipo de publicación: Artículo de Revista

 DOI: 10.1016/j.humimm.2024.110806

 ISSN: 0198-8859,1879-1166

 Url de la publicación: https://doi.org/10.1016/j.humimm.2024.110806

Autoría

ALEJANDRA COMINS BOO

JUAN IRURE VENTURA

VALENTIN, MARÍA O.

LARA BELMAR VEGA

LÓPEZ DEL MORAL CUESTA, COVADONGA

ROSALIA MARIA VALERO SAN CECILIO

RENUNCIO-GARCÍA, MÓNICA

CAROLINA CASTRO HERNANDEZ

MIKAHLKOVICH, DZMITRY

MOTA PÉREZ, NEREA

DAVID SAN SEGUNDO ARRIBAS