Nephrology

449 Immunosuppression In Highly Sensitized Patients

  • Immunosuppression In Highly Sensitized Patients

    Highly sensitized patients are those who have had a previous immediate acute rejection or have cytotoxic antibodies to more than 50% of the panel. They have a marked increase in graft loss due to acute rejection.

    Pre-Operative

    1. Usual pre-hydration volumes are given
    2. Two-volume (80 ml/kg) plasma exchange with 5% albumin initially (60 ml/kg) and then FFP (20 ml/kg)
    3. Cyclosporin A, 4 mg/kg, oral or IV in 100 ml 0.9% saline over about 1 hour
    4. Mycophenolate Mofetil 600mg/m2 at end of plasma exchange
    5. First dose of basiliximab (Simulect, Novartis) given within 2 hours of transplant operation

    Intra-Operative

    1. Methyl Prednisolone 500 mg IV at commencement of venous anastonosis
    2. Flucloxacillin 50mg/kg IV at induction (if allergic Vancomycin or Cefotaxime)

    Post-Operative

    1. Second dose of basiliximab (Day 4)
    2. Mycophenolate 600mg/m2 per dose (given 12 hourly)
    3. Prednisolone per usual dose
    4. Cyclosporin per usual dose

    All other management is as in non-sensitized patients

    Anti-CD 25 Antibodies

    Basixilimab (Simulect, Novartis)

    Dosage:- 12mg/m2 - max 20 mg given IV. Drug is reconstituted in5ml water and infused over 20 minutes

    1. 1st dose pre-operatively post plasma exchange
    2. 2nd dose Day 4