Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 14, Issue 12, Pages 2807-2813Publisher
WILEY
DOI: 10.1111/ajt.12920
Keywords
clinical research; practice; kidney transplantation; nephrology; ABO incompatibility; immunosuppressive regimens; rejection: anti-body mediated (ABMR); kidney transplantation: living donor
Categories
Ask authors/readers for more resources
ABO incompatible living donor renal transplantation (ABOi) can achieve outcomes comparable to ABO compatible transplantation (ABOc). However, with the exception of blood group A2 kidneys transplanted into recipients with low titer anti-A antibody, regimens generally include antibody removal, intensified immunosuppression and splenectomy or rituximab. We now report a series of 20 successful renal transplants across a range of blood group incompatibilities using conventional immunosuppression alone in recipients with low baseline anti-blood group antibody (ABGAb) titers. Incompatibilities were A(1) to O (3), A(1) to B (2), A(2) to O (2), AB to A (2), AB to B (1), B to A(1) (9), B to O (1); titers 1:1 to 1:16 by Ortho. At 36 months, patient and graft survival are 100%. Antibody-mediated rejection (AbMR) occurred in one patient with thrombophilia and low level donor-specific anti-HLA antibody. Four patients experienced cellular rejection (two subclinical), which responded to oral prednisolone. This series demonstrates that selected patients with low titer ABGAb can undergo ABOi with standard immunosuppression alone, suggesting baseline titer as a reliable predictor of AbMR. This reduces morbidity and cost of ABOi for patients with low titer ABGAb and increases the possibility of ABOi from deceased donors. The authors describe successful ABO-incompatible renal transplantation without antibody removal in recipients with constitutively low baseline anti-blood group antibody levels using conventional immunosuppression alone without rituximab or splenectomy.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available