The Effect of Desensitization on Sequel of Anti-MICA Antibody on Renal Graft Function in Live Related Renal Transplant – A Case Control Study

Abstract

Introduction:Renal transplantation is distinctive remedial measure of choice in cases of end stage renal disease, but the beneficiary with pretransplant HLA and non HLA antibodies present a unique challenge to the transplant community. However over the decades several desensitization protocols have been deployed which have allowed successful transplantation in HLA antibodies positive patients, but the data is quite limited with respect to the non HLA antibodies like anti-MICA antibody that to in Indian scenario. Our study focused on assessing the overall outcome for anti-MICA antibody on renal graft function.

Material and Methods:Prospective case control study was donewhere outcome of 50 anti-MICA antibody positive renal transplant recipients (Group I) was compared with 50 anti-MICA antibody negative renal transplant recipients (Group II).Group I recipients underwent a desensitization protocol using combination of Rituximab, PLEX and IV Ig.

Results:Mean serum creatinine levels were higher at all the intervals in Group I over six month observation period but there was no significant divergence notedamongst both the groups. We observed that history of blood transfusion and longer waiting period on dialysis poses a significant risk of sensitization to MICA antigen. Rejection rate, graft function and patient survival after six months of follow up, post transplantation were comparable between both the groups.

Conclusion: This beneficial effect can be attributed to the desensitization of anti-MICA antibody positive cases prior to the transplant. We opine,a combination of Rituximab, PLEX + IV Ig is reasonable choice to keep check on acute rejection without significantly enduring to the risk of opportunistic and other severe infections in such sensitized patients.