Renal Transplantation in High Immunological Risk Patients: A Single-Center Experience Nadir Alpay a, *, Ümit Özçelik b , Eryi  git Eren c , and Bora Uslu d a Department of Nephrology, _ Istanbul Aydın University Training and Research Hospital; b Department of General Surgery, Istanbul Aydın University Training and Research Hospital; c Department of General Surgery, Istinye University Training and Research Hospital; and d Department of Nephrology, Istinye University Training and Research Hospital ABSTRACT Background. Renal transplantation (RT) in high-risk patients is increasingly performed due to an inadequate organ pool and increased rate of RT after a failed transplantation. Safety and prognosis of RT in such patients with high risk is an ongoing debate. Herein we aimed to present our single-center experience on RT of high-risk patients. Methods. A total of 89 consecutive RT patients were included into this study in a 10- month period. Patients were divided into 3 groups: the low-risk group (n ¼ 47) with negative panel reactive antibody (PRA), medium-risk group (n ¼ 18) with positive PRA but mean fluorescence intensity (MFI) < 2000, and high-risk group (n ¼ 24) with positive PRA and MFI >2000 or donor specific antibody (DSA) positivity. Groups were compared in terms of demographic features, serum creatinine levels, acute rejection rates, delayed graft function (DGF), and patient or graft loss. Results. Age of the recipients were similar between the groups. Desensitization (7% vs 11% vs 42%, respectively, in low-, medium-, and high-risk groups; P ¼ .001), plasmapheresis (6% vs 11% vs 46%, respectively, P < .001), and rituximab treatments (0% vs 0% vs 25%, respectively, P < .001) were significantly more frequently performed in high-risk patients. Serum creatinine levels at 1 month and 6 months after RT were similar between the groups (P ¼ .43 and P ¼ .71, respectively). Rates of acute rejection (6% vs 6% vs 16%, respectively, P ¼ .52) and DGF (9% vs 11% vs 29%, respectively, P ¼ .15) were similar between the groups. Frequencies of loss of patient or graft were also similar (0% vs 6% vs 4%, P ¼ .15). Conclusion. RT may be successfully performed in high-risk patients without an increase in the risk of acute rejection, DGF, or patient/graft loss. R ENAL transplantation (RT) is known to be associated with improved survival and quality of life compared to patients on dialysis. However, highly sensitized RT candi- dates usually have long waiting times, causing increased morbidity and mortality in this patient population [1]. Recent advances to overcome this issue include desensitization protocols and paired donor exchange. RT in high-risk pa- tients is increasingly performed due to inadequate organ pool and increased rate of RT after a failed transplantation. Safety and prognosis of RT in such patients with high risk is an ongoing debate. Herein we aimed to present our single- center experience on RT of high-risk patients. MATERIALS AND METHODS A total of 89 consecutive RT patients were included in this study during a 10-month period. All patients received induction treatment with anthymocyte globulin and standard immunosuppressive *Address correspondence to Nadir Alpay, _ Istanbul Aydın Uni- versity School of Medicine, _ Istanbul Aydın University Training and Research Hospital, Department of Nephrology, Bes¸ yol Mahallesi, Akasya Sokak no: 4, Küçükçekmece, 34295, Istanbul, Turkey. Tel: þ90 505 713 9779, Fax: þ90 212 979 5999. E-mail: drnadiralpay@hotmail.com 0041-1345/19 https://doi.org/10.1016/j.transproceed.2019.04.075 ª 2019 Published by Elsevier Inc. 230 Park Avenue, New York, NY 10169 2298 Transplantation Proceedings, 51, 2298e2301 (2019)