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Should kidney transplant be done with a positive HLA crossmatch?

Q: My 30 years old wife is suffering from chronic kidney disease and is on dialysis. We are thinking of getting a kidney transplant done. The doctor conducted a pre-transplant HLA cross-matching of patient's serum with donor's lymphocytes, which has turned out to be Positive (60%). The doctor has told us that we cannot go ahead with the transplant and we will have to wait for another 2-3 months and carry out the test again to find if that has reduced to 10% or turned negative. Is the doctor right?

A:Kidney transplantation should not be done in presence of a positive HLA Crossmatch. This is due to presence of antibodies against donor HLA antigens. These antibodies might slowly decrease or could be removed by plasmapheresis. One could also use simultaneously drugs like ATG injections to prevent new antibody formation. The other alternative could be to find another family donor preferably brother or sister to have better chances of crossmatch negativity.


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