Induction Therapy
Should I be concerned about this situation: positive B-cell crossmatch (IgM), autoantibody negative, and panel reactive antibody (PRA) 0% in first-time, living-related kidney transplantation? What is the appropriate induction protocol?

Adisorn Lumpaopong, MD

The clinical relevance of donor-reactive IgM antibodies is not clear. Thus, the optimal immunosuppression management of these patients remains to be determined. Ideally, to rule out IgG antibodies, it would be useful to repeat the test in 6 weeks and if the antibodies are still of the IgM class, the risk of humoral rejection is lessened. It would be important to determine that the reported PRA has been performed by flow cytometry rather than cytotoxicity methods, as flow cytometry is more sensitive. So, if the PRA is 0% by flow cytometry, the antibodies are IgM and the risk of humoral rejection is low. However, the use of depleting induction therapy may be reasonable followed by triple immunosuppressive therapy. I do not believe there is a need for intravenous immunoglobulin, rituximab, or pheresis.

Supported by an independent educational grant from Fujisawa Healthcare.