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Case Reports in Transplantation
Volume 2011, Article ID 370596, 4 pages
http://dx.doi.org/10.1155/2011/370596
Case Report

Pediatric Renal Transplantation in a Highly Sensitised Child—8 Years On

1Paediatric Renal Transplant Centre, The Children’s University Hospital, Temple Street, Dublin 1, Ireland
2Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
3Renal Transplant Unit, Beaumont Hospital, Dublin 9, Ireland
4National Histocompatibility and Immunogenetics Services for Solid Organ Transplantation, Beaumont Hospital, Dublin 9, Ireland

Received 24 November 2011; Accepted 25 December 2011

Academic Editors: J. A. Kari and M. Sadeghi

Copyright © 2011 Catherine Quinlan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Highly sensitised children have markedly reduced chances of receiving a successful deceased donor renal transplant, increased risk of rejection, and decreased graft survival. There is limited experience with the long-term followup of children who have undergone desensitization. Following 2 failed transplants, our patient was highly sensitised. She had some immunological response to intravenous immunoglobulin (IVIg) but this was not sustained. We developed a protocol involving sequential therapies with rituximab, IVIg, and plasma exchange. Immunosuppressant therapy at transplantation consisted of basiliximab, tacrolimus, mycophenolate mofetil, and steroids. At the time of transplantation, historical crossmatch was ignored. Current CDC crossmatch was negative, but T and B cell flow crossmatch was positive, due to donor-specific HLA Class I antibodies. Further plasma exchange and immunoglobulin therapy were given pre- and postoperatively. Our patient received a deceased donor-kidney-bearing HLA antigens to which she originally had antibodies, which would have precluded transplant. The graft kidney continues to function well 8 years posttransplant.