Renal re-transplantation in a pre-sensitized small infant and literature review

Objective To explore the feasibility and safety of kidney transplantation for pre-sensitized infants using deceased donors and summarize the relevant literature reports. Methods A second kidney transplantation was successfully performed for an 8-month-old pre-sensitized girl in July 2017. She had a low level of donor specific antibody (DSA) against human leucocyte antigen (HLA) B62 due to severe acute rejection (AR) after her first kidney transplantation. For desensitization, plasmapheresis and intravenous immunoglobulin plus anti-CD20 antibodies were offered on operative day. Clinical data and outcomes were retrospectively analyzed. Results Renal graft regained immediate function after transplantation. Preformed DSA could be detected at 1 week. However, there was no de novo DSA. At 1 year post-transplantation, preformed DSA turned negative. During a follow-up period of 2 years, renal graft showed an excellent function with a serum creatinine of 31 μmol/l and eGFR of 110 ml/min/1.73m2. No AR episode or proteinuria occurred. DSA stayed negative. Simultaneously physical development also caught up. Her height of 93 cm tall and weight of 13.5 kg at month 24 & 8 months corresponded to normal growth curve of her age. Conclusions Pre-sensitized infant could tolerate desensitization therapy well and achieve satisfactory outcomes. With surgical precisions and optimized managements, kidney transplantation provides excellent renal functions and survivals for infants with organs from deceased donors. Key words: Infant; Kidney transplantation; Pre-sensitization; Human leucocyte antigen; Donor specific antibodies