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Background: Pretransplant desensitization protocols, including plasmapheresis, intravenous immunoglobulin, induction antibody therapy, and intensive maintenance immunosuppression, are generally employed in kidney transplant recipients who have positive status for donor-specific anti-HLA antibody (DSA). To avoid serious infectious complications, the authors designed a novel low-dose protocol in Thai patients undergoing DSA+ living-related kidney transplantation (LRKT)., Methods: A retrospective cohort study of the patients who underwent DSA+ LRKT was conducted. The novel protocol consisted of 3 to 5 sessions of pretransplant double-filtration plasmapheresis (DFPP) with or without low-dose intravenous immunoglobulin together with low-dose anti-thymocyte globulin (ATG) induction (1-1.5 mg/kg/d for 3-4 days) and low-dose tacrolimus (Tac) (trough level 5-10 ng/mL), mycophenolate, and prednisolone., Results: The study included 17 patients. The lymphocyte crossmatch via complement-dependent cytotoxicity was negative in 12 patients and positive for B cell immunoglobulin M in 5 patients. The novel desensitization protocol resulted in a decrease of at least 50% of DSA mean fluorescence intensity from baseline (from 4320 ± 549 before DFPP to 1601 ± 350 before transplantation, P < .005) and successful kidney transplantation with good allograft function in all cases. Early DSA rebound was observed in 3 patients after transplantation, and kidney biopsy revealed subclinical antibody-mediated rejection in 1 patient and diffuse C4d staining without cell infiltration in 2 patients. There were good long-term outcomes in patient and graft survival (100% and 94.1%, respectively). Only 1 allograft loss occurred because of nonadherence. The majority of patients have stable allograft function with serum creatinine less than 1.5 mg/dL. However, infections, including CMV and other organisms, were commonly observed., Conclusions: Desensitization protocol with DFPP, low-dose ATG, and Tac provides excellent outcomes in living donor kidney transplantation in highly sensitized Asian populations., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background and Objectives: HLA matching at the A, B, and DR loci influences the graft survival rate of deceased donor kidney transplants. The effect of HLA-DQB1 matching on transplant outcomes is still controversial. The aim of this study was to investigate the association of HLA-DQB1 matching with allograft outcomes in deceased donor kidney transplant recipients., Methods: A retrospective analysis of deceased donor kidney transplant recipients between 2008 and 2014 at the Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand, was performed. Donor-recipient HLA matching at DQB1 locus was analyzed. The association between HLA-DQB1 mismatches and transplant outcomes was investigated using adjusted Cox regression analysis., Results: A total of 383 deceased donor kidney transplants were performed during the study period, of which 297 with complete clinical and laboratory data were analyzed. The median follow-up time of all patients was 41 months (range, 16.4-65.6 months). Of the 297 recipients, 107 (36.03%) received 0 HLA-DQB1 mismatched kidneys and 190 (63.97%) received 1 or 2 HLA-DQB1 mismatched kidneys. Recipients who have received 1 or 2 HLA-DQB1 mismatched kidneys had a higher risk of acute rejection, with the adjusted hazard ratio of 4.35 (95% CI, 1.41-13.42; P = .01). However, HLA-DQB1 mismatching was not associated with chronic rejection and graft survival., Conclusion: Donor-recipient HLA-DQB1 mismatching is associated with acute rejection in deceased donor kidney transplants. However HLA-DQB1 mismatching does not have a negative impact on chronic rejection or graft survival., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Dual kidney transplants (DKTs) from expanded criteria donors (ECDs) have been performed in our hospital since 2014. We needed to review our clinical outcome and update criteria to selected ECDs for DKTs., Materials and Methods: Between January 2014 and December 2016, 4 DKTs and 269 deceased donor kidney transplants were performed. The outcome of DKTs was reviewed. The literature was reviewed for surgical technique and indication for DKT., Results: Four DKTs were performed between 2014 and 2016. One-year graft survival rate was 100%. One patient developed delayed graft function. No morbidity or mortality occurred., Conclusions: DKTs in our center were safe and had good outcome with optimized selected criteria. DKT can improve the rate of kidney transplant in a developing country., (Copyright © 2018 Elsevier Inc. All rights reserved.)