ABO-incompatible kidney transplantation of an 8-yr-old girl with donor/recipient-constellation A1B/B
| Autor: | Jürgen Klempnauer, Kerstin Froede, Hans-Gert Heuft, Gisela Offner, Anke Schwarz, Jürgen Strehlau, Lars Pape, Jochen H. H. Ehrich, Thurid Ahlenstiel |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
medicine.medical_specialty
Time Factors medicine.medical_treatment Immunology Renal function Kidney Gastroenterology ABO Blood-Group System Focal segmental glomerulosclerosis Internal medicine Living Donors medicine Humans Antigens Child Immunoadsorption Kidney transplantation Transplantation business.industry Immunosuppression medicine.disease Kidney Transplantation Surgery Blood Group Incompatibility Female Rituximab Hemodialysis business Immunosuppressive Agents medicine.drug |
| Zdroj: | Xenotransplantation. 13:141-147 |
| ISSN: | 1399-3089 0908-665X |
| DOI: | 10.1111/j.1399-3089.2006.00279.x |
| Popis: | Background: Antigen-specific immunoadsorption combined with rituximab offers the possibility for ABO-incompatible kidney transplantation without splenectomy. Patient and method: An 8-year-old mentally retarded girl with steroid-resistant nephrotic syndrome and focal segmental glomerulosclerosis due to mitochondriopathy poorly tolerated hemodialysis. Paternal blood group A1B was incompatible with blood group B of the child. Therefore, we decided to perform the first ABO-incompatible renal transplantation in a child in Germany using antigen-specific immunoadsorption. Rituximab (1 × 375 mg/m2) was administered 2 weeks before the first immunoadsorption (Glycosorb® ABO A-column). Triple-drug immunosuppression (tacrolimus, mycophenolate mofetil and prednisolone) was simultaneously started with immunoadsorption. Initial tacrolimus levels were targeted between 15 and 20 ng/ml. Before transplantation, six immunoadsorptions were applied on days −9, −7, −4, −3, −2 and −1. Intravenous immunoglobulin (0.5 g/kg) was administered preoperatively. After transplantation, three immunoadsorptions were performed on days +4, +6 and +8. Results: Before transplantation, antibody (Ab) titers against paternal erythrocytes (20°C) were reduced from 1 : 64 to 1 : 4 by six antigen-specific immunoadsorptions. After transplantation, we performed three more immunoadsorptions and the Ab titers were stable between 1 : 1 and 1 : 8. One, 2 and 8 months later we observed increases in the Ab titer up to 1 : 32 requiring no change in immunosuppressive therapy. No side effects of immunoadsorption were observed. The girl had excellent initial graft function with a serum creatinine of 55 to 70 μmol/l. Two weeks after transplantation, graft biopsy showed no signs of rejection; there was focal positivity for C4d only. Twelve months after transplantation, renal function was stable, with a serum creatinine of 117 μmol/l. Episodes of rejection or severe infections were absent. Conclusion: ABO-incompatible transplantation using antigen-specific immunoadsorption and rituximab may serve as a suitable alternative for children urgently needing renal transplantation and missing a blood group-compatible donor. |
| Databáze: | OpenAIRE |
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