Noriega-Salas L, Bernáldez-Gómez G, Robledo-Meléndez A, Pérez-Padilla A, Desentis-Huitrón D, Zoquiapa-Galaviz E, Cruz-Santiago J, Escarramán-Martínez D

Language: Spanish
References: 23
Page: 116-122
PDF size: 310.33 Kb.

ABSTRACT

Renal transplantation emerges as the preferred therapeutic option for chronic kidney disease, offering significant improvements in patient survival and quality of life. However, access to this procedure can vary by country and donor availability. In Mexico, the low rate of deceased donors presents a significant challenge, with waiting times exceeding 10 years for some patients. In this context, renal transplant programs are increasingly relying on living donors as the primary source of organs. Pre-transplant desensitization therapy has emerged as a crucial strategy to address immunological challenges in these programs, offering the opportunity to access renal transplantation. We present our experience in the evolution of a desensitization program at a Renal Transplant Reference Center in Mexico, highlighting the importance of continuously adapting treatment protocols to improve clinical outcomes and reduce complications. Through a retrospective cohort study, we observed encouraging results in terms of graft and patient survival, supporting the efficacy and clinical relevance of desensitization in renal transplantation. Although challenges and limitations persist, our experience emphasizes the importance of this therapy as a valid option in managing chronic kidney disease.

REFERENCES

1. Fernández C, Calvo M, Leite N, López A, Ferreiro T, Ribera R et al. Kidney transplantation from HLA-incompatible live donors: Efficiency and outcome of 32 patients after desensitisation. Nefrologia. 2017; 37 (6): 638-645.

2. Gobierno de México. Presentación Anual 2019. 2019. Recuperado de https://www.gob.mx/cms/uploads/attachment/file/528301/Presentacion_anual_2019.pdf

3. Global observatory on donation and transplantation. GODT. Disponible en: https://www.transplant-observatory.org/

4. Pacientes en espera de un órgano o tejido al 30 de junio de 2020. Plataforma Nacional de Datos Abiertos. (n.d.). Gob.mx. Retrieved August 27, 2025. Disponible en: https://datos.gob.mx/dataset/pacientes_espera_organo_tejido

5. Madrigal-Bustamante JA, Vilatobá-Chapa M, G-Contreras A, Sánchez-Cedillo A, Castañeda-González HO, López- Jiménez JL et al. Sistema de puntaje para asignación de riñones de donante fallecido a pacientes en lista de espera para trasplante. Rev Mex Traspl. 2014; 3 (2): 49-55.

6. Montgomery RA, Lonze BE, King KE, Kraus ES, Kucirka LM, Locke JE et al. Desensitization in HLA-incompatible kidney recipients and survival. N Engl J Med. 2011; 365 (4): 318-326.

7. Martinez-Mier G, Gonzalez-Carrera MO, Vega-Quesada HG, Salazar-Pérez M, Viñas-Dozal JC, Moreno-Ley PI et al. Annual analysis (2018) of the kidney transplant waiting list of a Social Security Hospital in Veracruz, Mexico. Transplant Proc. 2020; 52 (4): 1087-1089.

8. Stegall MD, Gloor J, Winters JL, Moore SB, Degoey S. A comparison of plasmapheresis versus high-dose IVIG desensitization in renal allograft recipients with high levels of donor specific alloantibody. Am J Transplant. 2006; 6 (2): 346-351.

9. Marfo K, Lu A, Ling M, Akalin E. Desensitization protocols and their outcome. Clin J Am Soc Nephrol. 2011; 6 (4): 922-936.

10. Jordan SC, Choi J, Vo A. Kidney transplantation in highly sensitized patients. Br Med Bull. 2015; 114 (1): 113-125. doi: 10.1093/bmb/ldv013.

11. Jin MK, Cho JH, Kwon O, Hong KD, Choi JY, Yoon SH et al. Successful kidney transplantation after desensitization using plasmapheresis, low-dose intravenous immunoglobulin, and rituximab in highly sensitized patients: a single-center experience. Transplant Proc. 2012; 44 (1): 200-203.

12. Vo AA, Peng A, Toyoda M, Kahwaji J, Cao K, Lai CH et al. Use of intravenous immune globulin and rituximab for desensitization of highly HLA-sensitized patients awaiting kidney transplantation. Transplantation. 2010; 89 (9): 1095-1102.

13. Ramos EJ, Pollinger HS, Stegall MD, Gloor JM, Dogan A, Grande JP. The effect of desensitization protocols on human splenic B-cell populations in vivo. Am J Transplant. 2007; 7 (2): 402-407.

14. Green H, Nesher E, Aizner S, Israeli M, Klein T, Zakai H et al. Long-term results of desensitization protocol with and without rituximab in sensitized kidney transplant recipients. Clin Transplant. 2019; 33 (6): e13562.

15. Gloor J, Stegall MD. Sensitized renal transplant recipients: current protocols and future directions. Nat Rev Nephrol. 2010; 6 (5): 297-306.

16. Kraus ES, Parekh RS, Oberai P, Lepley D, Segev DL, Bagnasco S et al. Subclinical rejection in stable positive crossmatch kidney transplant patients: incidence and correlations. Am J Transplant. 2009; 9 (8): 1826-1834.

17. Henderson LK, Nankivell BJ, Chapman JR. Surveillance protocol kidney transplant biopsies: their evolving role in clinical practice. Am J Transplant. 2011; 11 (8): 1570-1575.

18. Zhang R. Donor-specific antibodies in kidney transplant recipients. Clin J Am Soc Nephrol. 2018; 13 (1): 182-192.

19. Burnier M, Pruijm M, Wuerzner G, Santschi V. Drug adherence in chronic kidney diseases and dialysis. Nephrol Dial Transplant. 2015; 30 (1): 39-44.

20. Cruz-Santiago J, Noriega-Salas L, Robledo-Meléndez A, Bernáldez-Gómez G, García-Ramírez C, Meza-Jiménez G et al. Adherencia a inmunoterapia en trasplante renal en un tercer nivel en México. Rev Mex Traspl. 2019; 8 (1): 5-13.

21. Kute VB, Vanikar AV, Trivedi HL, Shah PR, Goplani KR, Patel HV et al. Desensitization protocol for highly sensitized renal transplant patients: a single-center experience. Saudi J Kidney Dis Transpl. 2011; 22 (4): 662-669.

22. Orandi BJ, Luo X, Massie AB, Garonzik-Wang JM, Lonze BE, Ahmed R et al. Survival benefit with kidney transplants from HLA-incompatible live donors. N Engl J Med. 2016; 374 (10): 940-950.

23. Hoyo I, Linares L, Cervera C, Almela M, Marcos MA, Sanclemente G et al. Epidemiology of pneumonia in kidney transplantation. Transplant Proc. 2010; 42 (8): 2938-2940.