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Re-Transplantation Sensitisation — ESENeph MCQ

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ModerateTransplantationRe-Transplantation SensitisationESENeph

A 38-year-old woman with a previous kidney transplant lost the graft after 5 years due to chronic rejection. She has been on haemodialysis for 2 years. She still has circulating DSA. She is being re-listed for a second transplant. What specific consideration applies?

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Correct answer: A — She is at higher immunological risk and may need desensitisation or more intensive induction

Re-transplant candidates, particularly those who lost the previous graft to rejection, are at significantly higher immunological risk. Circulating DSA indicate pre-sensitisation and increase the risk of AMR in a subsequent transplant. Management includes careful HLA matching, avoiding antigens targeted by existing DSA, considering desensitisation protocols, and more intensive induction (ATG rather than Basiliximab). Virtual crossmatch is essential.

Reference: KDIGO 2020 – Transplant Candidate Evaluation; BTS 2018 – Sensitisation Guidelines