Platelet based regimen in desensitization of highly sensitized patients with kidney transplantation. A novel therapy.

BACKGROUND: Kidney transplantation remains the best treatment for patients with renal failure. Some patients, however, have high levels of anti-human leukocyte antigen (anti-HLA) antibodies so transplantation is not possible for them. To address this, we used desensitization, where plasmapheresis and intravenous immunoglobulin replaced with a new platelet-based approach to lower costs and reduce complications. We then assessed graft survival after transplantation. METHODS: In this historical cohort study, we enrolled 48 patients with calculated panel of reactive antibodies (cPRA) levels greater than 90% who were eligible for desensitization between 2018 and 2024. All patients received a desensitization regimen consisting of bortezomib, rituximab, and platelets, followed by kidney transplantation. Post-transplant, all patients were monitored for graft and patient survival. RESULTS: Among the 48 transplanted patients, only three (6.3%) experienced acute rejection during the six-year follow-up period. The six-year censored graft and patient survival were 98% and 97% calculated using the life-table method. Patient survival for one and six years was 97% and 68%, respectively. CONCLUSION: The study demonstrated that a desensitization regimen combining rituximab, bortezomib and platelets effectively reduced cPRA in highly sensitized patients, thereby enhancing their eligibility for transplantation. Additionally, this approach is associated with a significant reduction in rejection rates compared to conventional desensitization regimens, highlighting its advantages in improving transplant outcomes.