{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:50:27Z","timestamp":1792698627536,"version":"4.5.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Kidney transplant (KT) candidates with very high calculated panel reactive alloantibody (cPRA &amp;gt;95%) have limited chances to receive an HLA-matched transplant unless they undergo pretransplant desensitization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the efficacy of immunoadsorption (IA) in desensitizing pretransplant KT candidates with high cPRA and positive crossmatch.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>This was a single-center retrospective cohort study involving highly HLA-sensitized patients (cPRA &amp;gt;85%). Forty-nine patients underwent HLA-incompatible (HLAi) KT, of whom 25 (51%) received kidneys from deceased donors. Of these 49 patients, 23 had either a positive complement-dependent cytotoxic cross-match (CDC) and\/or a positive flow cytometry cross-match (FCM). The remaining 26 patients had donor-specific anti-HLA (DSAs) detectable only by Luminex (CDC and FCM cross-matches were negative). Only CDC-positive and FCM-positive patients were desensitized. These 49 patients were compared with 160 patients who had cPRA &amp;gt;85% but underwent HLA-compatible (HLAc) KT, i.e., without pretransplant DSAs.<\/jats:p><jats:p>Pretransplant desensitization included IA sessions, rituximab, tacrolimus, steroids, and mycophenolate mofetil. Induction therapy consisted of antithymocyte globulins.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean follow-up duration was 7.4 \u00b1 4 years. At 1-year and at last follow-up, 43 patient and death-censored graft survival rates were similar between HLAc and HLAi patients. However, HLAi patients experienced significantly more biopsy-proven rejections compared to HLAc patients. These\u00a0rejections were predominantly antibody-mediated. Finally, the rate of infectious complications was similar between HLAc and HLAi patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>IA in addition to immunosuppression is an effective option for desensitizing HLAi patients, yielding favorable long-term outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1612462","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T04:10:30Z","timestamp":1750651830000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Kidney transplant outcomes in HLA desensitized patients with pretransplant CDC and\/or FCM positive 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