Proceso de desensibilización ANTI-HLA en receptores de donante vivo HLA Clase II incompatible con anticuerpos donante específico

[ANTI-HLA desensitization process in HLA II incompatible living donor recipients with specific donor antibodies]

Autores/as

  • Karen Courville Hospital Dr. Gustavo Nelson Collado
  • Norman Emilio Bustamante Hospital Dr. Gustavo Nelson Collado
  • Maydeline Pecchio Hospital Dr. Gustavo N. Collado
  • Luis Ortiz Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid
  • Alejandro Vernaza-Kwiers Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid

Palabras clave:

desensibilización, transplante renal, anticuerpos anti HLA II, recambio plasmático, anticuerpos donantes específicos

Keywords:

desensitization, kidney transplantation, anti-HLA-II, antibodies, plasma exchange, donor'specific antibodies,

Resumen

Introducción: El trasplante renal es la opción terapéutica que ofrece la mejor expectativa de vida en los pacientes con enfermedad renal crónica. Muchos pacientes sensibilizados permanecen largo tiempo en lista de espera, aumentando su morbi-mortalidad en diálisis.

Objetivos: evaluar el uso de terapia de desensibilización en pacientes con anticuerpos anti HLA Clase II contra su donante vivo relacionado, identificar factores de riesgo temprano de requerimiento de biopsia renal por sospecha de rechazo y evaluar los costos relacionados.

Resultados: Realizamos valoración de terapia de desensibilización a 3 pacientes, con una disminución en los valores de anticuerpos donante específico a menos de 1000 de MFI, con un índice de RIS bajo, por lo que se procedió con el trasplante, sin complicaciones inmediatas y con un seguimiento a 18 meses sin deterioro de función renal.

Conclusiones: La desensibilización previa a trasplante renal permite disminuir el título de anticuerpos donantes específicos preformados y llevar a cabo el trasplante renal, con una buena evolución del paciente y del injerto superior a permanecer en diálisis.


Abstract

Introduction: Renal transplantation is the therapeutic option that offers the best life expectancy in patients with chronic kidney disease. Many sensitized patients remain on the waiting list for a long time, increasing their morbidity-mortality on dialysis.

Objectives: to evaluate the use of desensitization therapy in patients with Class II HLA antibodies against their related living donor, identify early risk factors for renal biopsy requirement for suspected rejection, and assess related costs.

Results: We perform desensitization therapy assessment to 3 patients, with a decrease in specific donor antibody values to less than 1000 MFI, with a low RIS index, so transplantation was carried out, without immediate complications and with a follow-up to 18 months without impaired renal function.

Conclusions: Pre-renal transplant desensitization reduces the titles of preformed specific donor antibodies and performs renal transplantation, with a good evolution of the patient and the graft, superior than remaining on dialysis.

Biografía del autor/a

Karen Courville, Hospital Dr. Gustavo Nelson Collado

Hospital Dr. Gustavo Nelson Collado

Medicina Interna y Nefrología

Jefe de Unidad de Hemodiálisis y Diálisis Peritoneal

 

Norman Emilio Bustamante, Hospital Dr. Gustavo Nelson Collado

Medicina Interna, Nefrología

Coordinador Programa de Glomerulopatía y Trasplante Renal

 

Maydeline Pecchio, Hospital Dr. Gustavo N. Collado

Medicina Interna, Infectología

Luis Ortiz, Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid

Laboratorio Nacional de Trasplante

Citas

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DOI:

10.37980/im.journal.rmdp.20211735

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2021-06-15

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