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2009, Número 5

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Cir Cir 2009; 77 (5)


Desensibilización y trasplante renal. Plasmaféresis-IVIG a dosis estándar en pacientes con alto riesgo inmunológico

Flores-Gama F, Mondragón-Ramírez GA, Bochicchio-Riccardelli T

Idioma: Español
Referencias bibliográficas: 36
Paginas: 369-374
Archivo PDF: 95.53 Kb.


RESUMEN

Introducción: Los pacientes con alto riesgo inmunológico siguen siendo relegados a la cada vez más larga lista de espera de un donador inmunológicamente compatible. El objetivo de esta comunicación es informar la experiencia de un centro de trasplantes en la desensibilización de pacientes con alto riesgo inmunológico.
Material y métodos: Estudio descriptivo y retrospectivo de todos los pacientes sometidos a trasplante renal de noviembre de 1999 a enero de 2008, en quienes se llevó a cabo desensibilización pretrasplante renal.
Resultados: Ocho pacientes presentaron aloinmunización (pruebas cruzadas positivas o panel reactivo de anticuerpos alto, PRA › 30%). La desensibilización se realizó mediante sesiones de plasmaféresis con recambio de 1.5 volúmenes plasmáticos, y posterior a cada una se administró una dosis estándar de inmunoglubulina intravenosa (IVIG 5 g/dosis). La inmunosupresión se inició en la primera sesión de plasmaféresis con base en un inhibidor de calcineurinas (tacrolimus); en seis pacientes se añadió mofetil micofenolato y en dos, sirolimus. En siete se obtuvieron pruebas cruzadas negativas con el donador previo al trasplante; en el octavo no se efectuaron. En dos se administró anticuerpos humanizados contra CD25 (20 mg/dosis de basiliximab). Todos los pacientes han mantenido función estable del injerto.
Conclusiones: De acuerdo con nuestra experiencia, la sobrevida del injerto renal en pacientes con alto riesgo inmunológico posterior a un adecuado protocolo de desensibilización y estrecha vigilancia postrasplante es similar a la observada en pacientes no sensibilizados, al menos durante el primer año del trasplante.


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