Background: Kidney transplantation has indisputably changed the dynamics of renal medicine and restored hope among patients coming across fatal end-stage renal disease (ESRD). However, sensitization of human leukocyte antigen (HLA) hampers kidney transplantation. Our transplant center used a modified desensitization protocol.

Methods: Desensitization protocol in our transplant center encompassed following mentioned strategy to achieve MFI values <1000 and negative CDC crossmatch for both T and B lymphocytes before proceeding for kidney transplantation: Two sessions of Plasmapheresis on day 1 and 2 → Injection Rituximab on day 2 after Plasmapheresis → No Plasmapheresis on day 3 → Eight sessions of Plasmapheresis after day 3 and IVIG 100mg/Kg/dose after each session of Plasmapheresis → Repeat HLA antibody detection test to confirm if DSAs are present against HLA with MFI values <1000 and CDC crossmatch is negative for both T and B lymphocytes; if NO then continue Plasmapheresis sessions with IVIG 100 mg/Kg/dose till MFI values are <1000 and CDC crossmatch is negative for both T and B lymphocytes or if YES then proceed for transplantation → Repeat dose of Rituximab post-transplantation.

Results: All the six cases had moderate levels of DSAs against HLA except for one case with MFI value of 17962. With implementation of our modified desensitization protocol, we achieved low levels of DSAs with MFI value <1000 (Table 1). Patients were successfully transplanted with no adverse outcomes, such as kidney allograft rejection, on follow up (Table 2).

Conclusion: In our transplant center, we successfully desensitized and transplanted six HLA sensitized kidney transplant candidates with moderate to high DSAs and T and B lymphocyte positive CDC crossmatch. Our desensitization protocol comprised of multiple plasmapheresis sessions with simultaneous low dose IVIG and Rituximab. Upon follow up, we did not witness any significant transplant related event such as allograft dysfunction or rejection.

Keywords: Kidney Transplantation; Donor Specific Antibodies; Human Leukocyte Antigen; Desensitization Protocol.