{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T13:03:35Z","timestamp":1772111015644,"version":"3.50.1"},"reference-count":16,"publisher":"Oxford University Press (OUP)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High levels of preformed anti-HLA antibodies dramatically diminish renal transplant outcomes. Most desensitization programmes guarantee good intermediate outcomes but quite disappointing long-term prognosis. The search for a fully compatible kidney increases time on the waiting list.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In February 2011, a nationwide hyperimmune programme (NHP) was begun in Italy: all available kidneys are primarily proposed to highly sensitized patients with a panel reactive antibody above 80%. In this manuscript, we evaluate the outcome of paediatric patients transplanted with this approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-one patients were transplanted. Complete data are available for 20 patients. Mean age at transplantation was 14.5 years [standard deviation (SD) \u00b1 5.5)]. Mean time on the waiting list was 29.3 months (SD \u00b1 27.5). Median follow-up was 29.2 months (range: 11.2\u201359.3). The average number of HLA mismatches in these patients was 2.3 versus 3.7 in 48 standard patients transplanted in the same period (P &amp;lt; 0.001). Only one graft was lost. Two cases of humoral rejection occurred and were successfully treated. No cellular rejection was reported. Median creatinine clearance was 84, 88, 77 and 77 mL\/min\/1.73 m2 respectively 1, 6, 12 and 24 months after transplant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Transplantation of sensitized patients avoiding prohibited antigens is feasible, at least in a selected cohort of patients. In order to be able to further improve this approach, which in our opinion is very successful, it would be necessary to expand the donor pool, possibly increasing the number of countries participating in the programme. In this series, time on the waiting list did not increase significantly. This allocation policy should ideally lead to an outcome comparable to that expected in standard patients, which is particularly desirable in young patients who have the longest life expectancy. Since long-term results of desensitization programmes are not (yet) convincing, we suggest that these programmes should be reserved for selected cases where compatible organs cannot be found within a reasonable time span.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfw369","type":"journal-article","created":{"date-parts":[[2016,10,14]],"date-time":"2016-10-14T20:49:12Z","timestamp":1476478152000},"source":"Crossref","is-referenced-by-count":1,"title":["Renal transplantation in sensitized children and young adults: a nationwide approach"],"prefix":"10.1093","author":[{"given":"Luca","family":"Dello Strologo","sequence":"first","affiliation":[{"name":"1 Nephrology and Transplant Unit, Bambino Ges\u00f9 Children's Hospital IRCCS, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luisa","family":"Murer","sequence":"additional","affiliation":[{"name":"2 Pediatric Nephrology, Dialysis and Transplant Unit, Department of Woman and Child Health, AziendaOspedaliera-University of Padova, Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabella","family":"Guzzo","sequence":"additional","affiliation":[{"name":"1 Nephrology and Transplant Unit, Bambino Ges\u00f9 Children's Hospital IRCCS, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Morolli","sequence":"additional","affiliation":[{"name":"1 Nephrology and Transplant Unit, Bambino Ges\u00f9 Children's Hospital IRCCS, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annalisa M.V.","family":"Pipicelli","sequence":"additional","affiliation":[{"name":"1 Nephrology and Transplant Unit, Bambino Ges\u00f9 Children's Hospital IRCCS, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Benetti","sequence":"additional","affiliation":[{"name":"2 Pediatric Nephrology, Dialysis and Transplant Unit, Department of Woman and Child Health, AziendaOspedaliera-University of Padova, Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Germana","family":"Longo","sequence":"additional","affiliation":[{"name":"2 Pediatric Nephrology, Dialysis and Transplant Unit, Department of Woman and Child Health, AziendaOspedaliera-University of Padova, Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Testa","sequence":"additional","affiliation":[{"name":"3 Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Ricci","sequence":"additional","affiliation":[{"name":"4 Italian National Transplant Centre, Italian National Institute of Health (ISS), Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Ginevri","sequence":"additional","affiliation":[{"name":"5 Nephrology Unit, G. Gaslini Institute, Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luciana","family":"Ghio","sequence":"additional","affiliation":[{"name":"3 Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Cardillo","sequence":"additional","affiliation":[{"name":"6 Organ and Tissue Transplant Immunology Laboratory, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonina","family":"Piazza","sequence":"additional","affiliation":[{"name":"7 National Research Council, IFT Unit of Rome S. Camillo Hospital, Regional Transplant Center Lazio (CRTL), S. Camillo Hospital, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Nanni Costa","sequence":"additional","affiliation":[{"name":"4 Italian National Transplant Centre, Italian National Institute of Health (ISS), Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2016,10,14]]},"reference":[{"key":"2025102312475558500_GFW369C1","doi-asserted-by":"crossref","first-page":"421","DOI":"10.2215\/CJN.01651105","article-title":"Presensitization: the problem and its management","volume":"1","author":"Jordan","year":"2006","journal-title":"Clin J Am Soc Nephrol"},{"key":"2025102312475558500_GFW369C2","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1038\/nrneph.2010.34","article-title":"Sensitized renal transplant recipients: current protocols and future directions","volume":"6","author":"Gloor","year":"2010","journal-title":"Nat Rev Nephrol"},{"key":"2025102312475558500_GFW369C3","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1111\/j.1600-6143.2008.02524.x","article-title":"Positive cross-match living donor kidney transplantation: longer-term outcomes","volume":"9","author":"Haririan","year":"2009","journal-title":"Am J Transplant"},{"key":"2025102312475558500_GFW369C4","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1111\/j.1600-6143.2006.01711.x","article-title":"Extremely high association between appearance of HLA antibodies and failure of kidney grafts in a five-year longitudinal study","volume":"7","author":"Mao","year":"2007","journal-title":"Am J Transplant"},{"key":"2025102312475558500_GFW369C5","doi-asserted-by":"crossref","first-page":"308986","DOI":"10.5402\/2013\/308986","article-title":"The psychosocial experience of patients with end-stage renal disease and its impact on quality of life: findings from a needs assessment to shape a service","volume":"2013","author":"Finnegan-John","year":"2013","journal-title":"ISRN Nephrol"},{"key":"2025102312475558500_GFW369C6","doi-asserted-by":"crossref","first-page":"3042","DOI":"10.1681\/ASN.2007030345","article-title":"Psychosocial aspects of chronic disease: ESRD as a paradigmatic illness","volume":"18","author":"Cukor","year":"2007","journal-title":"J Am Soc Nephrol"},{"key":"2025102312475558500_GFW369C7","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1053\/j.ackd.2007.07.007","article-title":"Depression in end-stage renal disease patients: a critical review","volume":"14","author":"Kimmel","year":"2007","journal-title":"Adv Chronic Kidney Dis"},{"key":"2025102312475558500_GFW369C8","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1053\/j.ajkd.2015.09.024","article-title":"Functional Dependence and Mortality in the International Dialysis Outcomes and Practice Patterns Study (DOPPS)","volume":"67","author":"Jassal","year":"2016","journal-title":"Am J Kidney Dis"},{"key":"2025102312475558500_GFW369C9","doi-asserted-by":"crossref","first-page":"2356","DOI":"10.1097\/TP.0000000000000741","article-title":"A phase I\/II trial of the interleukin-6 receptor specific humanized monoclonal (tocilizumab) + intravenous immunoglobulin in difficult to desensitize patients","volume":"99","author":"Vo","year":"2015","journal-title":"Transplantation"},{"key":"2025102312475558500_GFW369C10","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1097\/TP.0000000000000064","article-title":"Benefits of rituximab combined with intravenous immunoglobulin for desensitization in kidney transplant recipients","volume":"98","author":"Vo","year":"2014","journal-title":"Transplantation"},{"key":"2025102312475558500_GFW369C11","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1056\/NEJMoa0707894","article-title":"Rituximab and intravenous immune globulin for desensitization during renal transplantation","volume":"359","author":"Vo","year":"2008","journal-title":"N Engl J Med"},{"key":"2025102312475558500_GFW369C12","doi-asserted-by":"crossref","first-page":"2405","DOI":"10.1111\/j.1600-6143.2011.03757.x","article-title":"Terminal complement inhibition decreases antibody-mediated rejection in sensitized renal transplant recipients","volume":"11","author":"Stegall","year":"2011","journal-title":"Am J Transplant"},{"key":"2025102312475558500_GFW369C13","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1111\/ajt.13168","article-title":"Positive crossmatch kidney transplant recipients treated with eculizumab: outcomes beyond 1 year","volume":"15","author":"Cornell","year":"2015","journal-title":"Am J Transplant"},{"key":"2025102312475558500_GFW369C14","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1097\/01.TP.0000129260.86766.67","article-title":"The acceptable mismatch program as a fast tool for highly sensitized patients awaiting a cadaveric kidney transplantation: short waiting time and excellent graft outcome","volume":"78","author":"Claas","year":"2004","journal-title":"Transplantation"},{"key":"2025102312475558500_GFW369C15","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.trim.2015.08.006","article-title":"The 25th anniversary of the Eurotransplant Acceptable Mismatch program for highly sensitized patients","volume":"33","author":"Heidt","year":"2015","journal-title":"Transpl Immunol"},{"key":"2025102312475558500_GFW369C16","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1097\/01.TP.0000438639.36838.ac","article-title":"Modeling the benefits and costs of integrating an acceptable HLA mismatch allocation model for highly sensitized patients","volume":"97","author":"Nguyen","year":"2014","journal-title":"Transplantation"}],"container-title":["Nephrology Dialysis Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/32\/1\/191\/9675204\/gfw369.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/32\/1\/191\/9675204\/gfw369.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T16:48:16Z","timestamp":1761238096000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ndt\/article\/32\/1\/191\/2327321"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,14]]},"references-count":16,"URL":"https:\/\/doi.org\/10.1093\/ndt\/gfw369","relation":{},"ISSN":["0931-0509","1460-2385"],"issn-type":[{"value":"0931-0509","type":"print"},{"value":"1460-2385","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10,14]]},"article-number":"gfw369"}}