Evaluation of Desensitization Protocols in HLA-incompatible Kidney-transplant Candidates
Status:
Terminated
Trial end date:
2019-11-21
Target enrollment:
Participant gender:
Summary
Kidney transplantation is the best renal-replacement in the setting of end-stage renal
disease. However, some transplant candidates have developed anti-HLA alloantibodies (human
leukocyte antigen). When they are numerous and when their strength assessed by mean
fluorescence intensity (MFI) is high it is very complicated to find-out a suitable kidney
allograft against which the recipient has a negative cross-match. In such a case the only
hope for the patient is desensitization therapy, whereby the treatment will decrease anti-HLA
alloantibodies below a threshold, i.e. MFI < 3,000, enabling kidney transplantation without
risking antibody-mediated rejection. Desensitization relies on i) apheresis technics in order
to withdraw circulating anti-HLA antibodies, and ii) immunosuppression, i.e. rituximab or
tocilizumab, targeting B-lymphocytes, and tacrolimus/mycophenolic acid/steroids targeting
T-cells. The type of apheresis is guided by the pre-desensitization MFI of anti-HLA
alloantibodies, e.g. double filtration plasmapheresis or semispecific immunoadsorption.
Likely the choice between rituximab and tocilizumab depends also on predesensitization
anti-HLA antibody MFIs. At the end of the desensitization process, the patient will be able
to get a kidney transplant either from a live-donor or from a deceased donor.