147  ABSTRACT Renal transplant in highly sensitised patients is associated with increased morbidity. The aim of this retrospective study was to evaluate the clinical evo- lution of 30 highly sensitised deceased donor kidney transplants and the influence of different timing of B cell directed treatment and its importance in the outcome of these patients. All recipients had negative complement dependent lymphocytotoxicity cytotoxic T cell crossmatch and no identified anti human leu- cocyte antigen class I donor specific antibodies. T cell flow crossmatch was performed within 24h of transplantation with serum obtained pretransplant (historic, recent or baseline). Posttransplant flow crossmatch were performed prospectively starting on the 3 rd posttransplantation day. The immunosuppres- sive regime included thymoglobulin, tacrolimus, mycofenolate mofetil and steroids. Positive flow crossmatch occurred in 20/29 patients by the 3 rd posttransplantation day, and in 17/27 patients after the 3 rd posttransplantation day. All patients were started on intravenous immuno- globulin before transplantation: in nine patients (group A) at 400mg/kg/day for five days; in the remaining 21 patients (group B), as a continued infusion of 2g/kg during 48h. In group A, Ritux- imab was added only in the presence of antibody mediated rejection; in group B, introduced on the 3 rd posttransplantation day whenever a positive flow crossmatch (with serum obtained pre or post- transplant) was reported. Antibody mediated rejection was observed in 44.4% of patients in group A, and 19% of those in group B. Mean follow-up was 12.2±5.5 months. Overall allograft survival was 76.6%, 81% in group B, and 66.6% in group A. At last follow up, mean serum crea- tinine was 1.3±0.6 mg/dl. Renal transplantation with pretransplant positive flow crossmatch is highly associated with antibody mediated rejection, despite introduction of intrave- nous immunoglobulin pretransplantation. However high dose intravenous immunoglobulin for 48h plus Rituximab by the 3 rd posttransplantation day reduce the incidence of antibody mediated rejection by more than 50% and allowed for allograft survival of 81% at one year, with an excellent renal function. Key-Words: Allograft survival; flow cytometry crossmatch; intra- venous immunoglobulin (IVIG); renal transplantation; Rituximab; sensitised patients. Transplantation in highly sensitised patients treated with intravenous immunoglobulin and Rituximab Ana Carina Ferreira 1 , Sandra Brum 1 , Vasco Fernandes 1 , Francisco Buinho 2 , Helena Viana 1 , Paula Alcântara 2 , Aníbal Ferreira 1 , Nuno Candeias 2 , João Sousa 1 , Alice Lima 3 , Fernanda Carvalho 1 , Hélder Trindade 3 , Fernando Nolasco 1, 2 1 Renal Transplantation Unit, Hospital de Curry Cabral. Lisbon, Portugal. 2 Transplantation Unit, Hospital da Cruz Vermelha Portuguesa. Lisbon, Portugal. 3 Centro de Histocompatibilidade do Sul. Lisbon, Portugal. Received for publication: 27/08/2009 Accepted in revised form: 02/12/2009 ORIGINAL ARTICLE Port J Nephrol Hypert 2010; 24(2): 147-151 Advance Access publication 1 February 2010