engleski

Immunization in kidney transplantation

Immunization towards Human Leukocyte Antigens (HLA) can occur through pregnancy, blood transfusion, or previous transplant. Determination of unacceptable and acceptable HLA antigen mismatches is a critical decision step in finding a suitable donor for the HLA immunized kidney recipients. The Eurotransplant Acceptable Mismatch (AM) program enhance transplantation of highly sensitized patients by allocating the kidney from the donors with HLA antigens to which the patient has never formed the antibodies. Here, we present the characteristics of a cohort of 56 active and immunized patients (34 male and 22 female) on kidney transplant waiting list on 1st of July 2022. Among 56 immunized patients, 28 (50%) had a previous transplantation, 14 of them as the only immunizing event, 11 received transfusion as well, while 3 female patients also had a pregnancy as the third immunizing event. A total of 30 (54%) immunized patients have the immunization to both class I and class II HLA antigens, 19 (34%) patients have only HLA class I immunization and 7 (12 %) are immunized only to class II HLA antigens. In the terms of virtual panel reactive antibodies (vPRA), 15 patients have vPRA over 98%, which makes them eligible for AM program. Among them, 14 patients (93%) had previous transplantation as the main immunizing event. Three of these patients are already registered in AM program, while five more are in a process of the registration. All together the HLA immunization profile of our patients is pointing to the previous transplantation as a major event leading to the high immunization that makes the patient eligible for the AM program. This also emphasizes the importance of donor-recipient HLA matching in the first transplantation, especially for children and young patients in which second transplantation is expected in the future.

immunization ; kidney transplantation

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