Case Scenario: Who, How, What and when not to : of desensitization.
Case Study: 40 y/o Female (Kudrat) is planning for her first transplant and has multiple possible donors, however she has multiple antibodies and hence is here for which donor transplant can proceed with. Her single antigen bead is positive and her immunological workup is below.
| Sensitization History | 2 Pregnancies | |||||
| HLA Typing | A | B | C | DR | DQ | DP |
| Father | 02:01, 11:01 | 40:02, 44:02 | 03:03, 05:01 | 09:01, 04:04 | 03:02, 03:03 | 02:01, 05:01 |
| Mother | 02:01, 30:01 | 13:02, 57:02 | 06:02, 18:02 | 15:03, 16:02 | 05:02, 06:03 | 02:01, 30:01 |
| Sister | 02:01, 11:01 | 40:02, 57:02 | 03:03, 18:02 | 09:01, 15:03 | 03:03, 06:03 | 05:01, 30:01 |
| Recipient | 11:01, 30:01 | 13:02, 40:02 | 03:03, 06:02 | 09:01, 16:02 | 03:03, 05:02 | 02:01, 05:01 |
| XM | T cells | B Cells | ||||
| CDC XM | Not Done | Not Done | ||||
| Flow XM | Not Done | Not Done | ||||
| Single Antigen Bead SAB Report – Click to View |
Class I : Multiple Anti HLA Abs | Class II: Multiple Anti HLA Abs. | ||||
Questions & Answers
Q1. No other potential donor, should we proceed for transplant?
Ans: Would get flow and CDC XM with mother or sister or both depending on other medical conditions. Can consider with the risks discussed above of AMR And graft loss.
If so, then which donor would you proceed with ? Mother or sister. Risk same.
Q2. What should we discuss with patient and family before proceeding for transplant?
Ans: AMR And graft loss.
Q3. What desensitization protocol would you plan?
Ans: Plasmapheresis, ATG and Increased maintenance immunosuppression.
Q4. What maintenance immunosuppression would you plan for her?
Ans: Increased doses of Tac, MMF (full dose as tolerated), higher prednisone 7.5/10 for longer… may not come to 5 ever…
