ABO Blood Group Incompatible Living Donor Kidney Transplantation without Splenectomy.
- Author:
Jin Min KONG
1
;
Dong Ryul LEE
;
Joon Heun JEONG
;
Jae Ho CHOI
;
Jung Oh LEE
;
Wha Rhim LEE
;
Byung Chang KIM
Author Information
1. Division of Nephrology, Maryknoll Medical Center, Busan, Korea.
- Publication Type:Original Article
- Keywords:
ABO incompatible kidney transplantation;
Antibody mediated rejection;
Rituximab
- MeSH:
Antibodies, Monoclonal, Murine-Derived;
Biopsy;
Creatinine;
Critical Period (Psychology);
Follow-Up Studies;
Humans;
Immunoglobulin G;
Immunoglobulin M;
Immunosuppressive Agents;
Kidney;
Kidney Transplantation;
Living Donors;
Plasmapheresis;
Rituximab;
Rejection (Psychology);
Splenectomy;
Tacrolimus;
Tissue Donors;
Transplants
- From:The Journal of the Korean Society for Transplantation
2009;23(1):71-76
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Serious organ shortage necessitates ABO incompatible (ABOi) kidney transplantation (KT). Recent reports utilizing rituximab instead of splenectomy and tacrolimus (FK)-based triple immunosuppressants showed excellent graft outcome. METHODS AND RESULTS: Thirteen cases of ABOi living donor KT have been performed since Feb. 2007 in our center. Donor and recipient blood group was B to O (n=5), A1 to O (2), AB to B (2), AB to A1 (1), A1 to B (2) and B to A1 (1). Rituximab was given at 4 weeks before transplantation. Plasmapheresis (PP) was initiated at 7~14 days before transplantation with concurrent immunosuppressants. The number of pretransplant PP was 5.7+/-1.4. Posttransplant PP was also performed in 6 patients with higher initial titer of ABO antibody (IgG > or =256; n=2), rapidly rising antibody titer during the critical period of 2 weeks posttransplantation (n=2), or increase in serum creatinine during the critical period while awaiting pathology report of graft biopsy (n=2). Mean number of posttransplant PP in these 6 patients was 2.2+/-1.3. Median IgG anti-ABO antibody titer before precondition, at transplantation, at 2 weeks and at 6 months was 64 (8~512), 2 (1~8), 2 (1~16) and 6 (1~16), respectively. IgM titer at corresponding time point was 16 (2~128). 1 (1~1), 1 (1~2) and 1.5 (1~4), respectively. Median follow up was 8 (5~27) months. No patient or graft was lost. No patient developed acute humoral rejection. Graft function remained stable with latest serum creatinine 1.2+/-0.3 mg/dl. CONCLUSIONS: ABOi living donor KT without splenectomy can be safely performed with the use of current preconditioning and immunosuppressive regimen, and is therefore a valuable option for expanding donor pool and should be actively performed in Korea.
