Outcomes of Kidney Transplantation in Highly HLA-Sensitized Patients Treated with Intravenous Immuno-Globulin, Plasmapheresis and Rituximab: A Meta-Analysis

Abstract

(1) Background: We aimed to investigate the outcomes of human leukocyte antigen (HLA)-incompatible transplantation for patients who received desensitization with intravenous immunoglobulins (IVIg), plasmapheresis, and rituximab. (2) Methods: A comprehensive search of multiple electronic databases to identify studies that utilized desensitization was conducted. The random-effects model was used to calculate the pooled rates and the 95% confidence interval (CI). (3) Results: A total of 1517 studies were initially identified. From these, 16 studies met the inclusion criteria, encompassing 459 patients, with a mean age of 45 years, of whom 40.8% were male. CDC crossmatch was positive in 68.3% (95% CI: 43.5–85.8; I2 87%), and 89.4% (95% CI: 53.4–98.4%; I2 89.8%) underwent living-donor transplantation. The 1-year graft survival pooled rate was 88.9% (95% CI: 84.8–92; I2 0%) and the 5-year graft survival rate was 86.1% (95% CI: 81.2–89.9; I2 0%). The 1-year patient survival rate was 94.2% (95% CI: 91–96.3; I2 0%), and the 5-year patient survival rate was 88.9% (95% CI: 83.5–92.7%; I2 7.7%). The rate of antibody-mediated rejection was 37.7% (95% CI: 25–52.3; I2 80.3%), and the rate of acute cell-mediated rejection was 15.1% (95% CI: 9.1–24; I2 55%). (4) Conclusions: Graft and patient survival are favorable in highly sensitized patients who undergo desensitization using IVIg, plasmapheresis, and rituximab for HLA-incompatible transplantation.

Keywords

• kidney transplant
• HLA desensitization
• antibody-mediated rejection
• anti-human leukocyte antigen
• donor-specific anti-human leukocyte antibody