Bone marrow aspiration for Highly Sensitized Prospective Kidney Transplant Recipients

Over 50% of all kidneys in the US are incompatible, with high levels of donor specific immunoglobulin M. A program based on DSA screening and early intervention as a strategy to prevent allograft rejection, in conjunction with immunosuppressive medications, is recommended to minimize allograft loss and optimize patient survival.

In a recent study, findings emphasizes the importance of immunosuppression for prevention of early rejection after kidney transplantation and is compatible with the hypothesis that high level of antibodies can be a cause for early rejection. In addition to our study there exist a number of studies that support the hypothesis that tacrolimus-based immunosuppressive therapy is associated with less rejection. Although our study needs to be extended with a larger number of recipients and a larger patient population, we think that treatment with tacrolimus or sirolimus might prevent early rejection in highly sensitized kidney transplant patients.

All patients who are highly sensitized may still benefit from [kidney transplant](https://www.withpower.com/clinical-trials/kidney-transplant)ation, but they have a higher complication rate and longer hospital stays. Nevertheless, with careful and precise management, they can enjoy an improved quality and a longer graft survival.

Specific signs of HSP-N KTX may be different for each individual patient. Some signs of HSP-N KTX were common among this group of patients and included skin itchiness, diarrhea and question: Does erythropoietin therapy decrease the need for dialysis in patients with chronic renal insufficiency? answer: Use of Epo is associated with an improvement in glomerular filtration rate in patients with CKD.

The use of ATG is very effective in preventing graft rejection and the immunosuppressive dose can be lowered by the use of mycophenolate mofetil. However, the most common treatment option is the use of tacrolimus.

In highly sensitized patients, the immunosuppressive treatment must be individualized; furthermore, an active strategy for the prevention of rejections and a selective treatment tailored to each individual are needed, as well as a strategy for guiding the discontinuation of the IS.

There is a growing amount of evidence suggesting IgG-Ab-mediated rejection of the transplanted kidney. The current understanding is that this is mediated by IgM-anti-FcgammaRIII antibodies which react to allo-HPAg-FcgammaR-III receptors on the surface of the podocytes.

The finding that half of the families were of two or more generations points to a genetic factor. As only a minority of these children had either previous or future antibody problems, it can be speculated that other genes or genes outside the HBB locus influence the development of HLA antibodies.

Based on these results and in contrast to the conclusions of one published study, our study provides no evidence that bone marrow aspiration improves quality of life for highly sensitized potential kidney transplant recipients while in the hospital for the dialysis phase of the maintenance treatment of the highly sensitized recipient.

The primary causes of HS PKTR were the following: antibody-mediated rejection, drug intolerance and rejection-related causes of HS. We suggest that there is no cause of HS PKTR.

The number of bone marrow biopsies in patients with no previous history of a febrile reaction (defined as a temperature > or = 102 F) is similar to that reported for those without history of fes. These data support performing a BM biopsy in all patients without history of fes.