Desensitization with plasmapheresis and Iv immunoglobulin is safe and effective in PRA positive kidney transplant recipient candidates in COVID-19 pandemic period

Purpose: High panel reactive antibody (PRA) levels may limit living-donor kidney transplantation (LDKT) according to increased risk of antibody mediated rejection. Desensitization may provide better graft survival rates in high-risk KT recipient candidates. We aimed to share our desensitization experience in LDKT recipients in COVID-19 pandemic period (March 1 to September 2, 2020). Methods: At Baskent University Transplantation Center, we performed desensitization protocol of plasmapheresis (5 sessions) and intravenous immunoglobulin(IVIG of 2g/kg) in three KT recipients who had high PRA levels. Results: Three sensitized KT recipients candidates had a mean age of 25.3 years and mean fluorescence intensity (MFI) level of 13862. All the patients were receiving their second transplant and had PRA class II positivity with percentages of 77%, 56% and 66% respectively. After desensitization, all the recipients became crossmatch negative and LDKT was performed successfully for all. No acute rejection episodes were detected either in the early period or in the three months period after LDKT. Patients had a mean creatinin level of 0,83 mg/dL in the 7th day and 0,88mg/ dL in the 3rd month after LDKT without significant proteinuria. No complication according to COVID-19 and no sign of infection was obtained. Conclusions: In conclusion, desensitization with 5 sessions of plasmapheresis and 2g/kg of IV immunoglobulin provide safe and effective desensitization in PRA positive LDKT recipients even in the COVID-19 pandemic period.