RESUMO
Desensitisation is a procedure undergone by the recipient of a kidney transplant from a donor who is cross-match positive. The aim of this study was to present the outcomes from our hospital of kidney transplant recipients from HLA-incompatible live donors after desensitisation. We studied 32 patients aged 46±14 years with a mean fluorescence intensity (MFI) versus class I HLA of 7979±4089 and 6825±4182 MFI versus class II and relative intensity scale (RIS) of 8.9±7.6. The complement-dependent cytotoxicity (CDC) cross-matching test was positive in 18 patients, flow cytometry was positive in 7 patients and donor-specific antibodies (DEA) were detected in 7. The protocol used was rituximab, plasmapheresis/immunoadsorption, immunoglobulins, tacrolimus, mycophenolic acid derivatives and prednisone. After 8±3 sessions of plasmapheresis/immunoadsorption, 23 patients were trasplanted (71.9%) and desensitisation was ineffective in 9. There were baseline differences in MFI class I (P<.001), RIS (P=.008), and CDC cross-matching, DSA and flow cytometry (P=.05). MFI class I and RIS were predictors of inefficiency in ROC curves. After follow-up of 43±30 months, 13 patients (56%) presented postoperative bleeding, 3 (13%) delayed graft function, 4 (17.4%) acute rejection, 6 (26%) CMV viraemia and 1 (4%) BK viraemia. Five-year patient survival was 90%, with 86% allograft survival. Five-year creatinine was 1.5±0.4 and proteinuria was 0.5±0.7. CONCLUSIONS: Kidney transplantation from HLA-incompatible live donors after desensitisation was possible in 71.9% of patients. MFI class I and RIS predict the inefficiency of desensitisation. Five-year allograft survival (86%) was acceptable with a low incidence of acute rejection (17.4%), although with a greater trend towards postoperative bleeding.
Assuntos
Dessensibilização Imunológica , Antígenos de Histocompatibilidade Classe I/imunologia , Transplante de Rim , Doadores Vivos , Adulto , Vírus BK , Infecções por Citomegalovirus/etiologia , Função Retardada do Enxerto/etiologia , Feminino , Sobrevivência de Enxerto , Teste de Histocompatibilidade , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Técnicas de Imunoadsorção , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Plasmaferese , Infecções por Polyomavirus/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prednisona/uso terapêutico , Curva ROC , Estudos Retrospectivos , Rituximab/uso terapêutico , Tacrolimo/uso terapêutico , Resultado do Tratamento , Infecções Tumorais por Vírus/etiologiaRESUMO
Atypical hemolytic uremic syndrome (aHUS) is a rare disease characterized by hemolysis, thrombocytopenia, and renal failure. It is related to genetic mutations of the alternative complement pathway and is difficult to differentiate from other prothrombotic microangiopathies. Eosinophilic granulomatosis with polyangiitis (EGPA) (Churg-Strauss syndrome, CSS) is a systemic ANCA-associated vasculitis and a hypereosinophilic disorder where eosinophils seem to induce cell apoptosis and necrosis and therefore, vasculitis. Here, we report the case of two CSS patients with a genetic complement disorder consistent with aHUS diagnosis. Both patients showed histologic features that supported the diagnosis of CSS, and a genetic complement study confirmed the suspected aHUS diagnosis. In the case where eculizumab was administered, the global response was excellent. There is very limited understanding of the genetics and epidemiology of both, atypical HUS and EGPA, but considering our two patients we suggest that an etiopathogenic link exists among patients diagnosed with both entities.