J Korean Soc Transplant.  2009 Jun;23(1):71-76.

ABO Blood Group Incompatible Living Donor Kidney Transplantation without Splenectomy

• Kong JM
• Lee DR
• Jeong JH
• Choi JH
• Lee JO
• Lee WR
• Kim BC

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.

Keyword

ABO incompatible kidney transplantation; Antibody mediated rejection; Rituximab

MeSH Terms

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
Antibodies, Monoclonal, Murine-Derived
Creatinine
Immunoglobulin G
Immunoglobulin M
Immunosuppressive Agents
Tacrolimus