ABO Incompatible Renal Transplantation Without Antibody Removal Using Conventional Immunosuppression Alone
| Autor: | Solomon Cohney, Nancy Suh, Rowan G. Walker, Michael N Haeusler, Amanda Robertson, Chris Hogan, Peter Hughes, Rosemary Masterson, R. J. Millar |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Graft Rejection Male Nephrology medicine.medical_specialty medicine.medical_treatment Kidney Function Tests Gastroenterology ABO Blood-Group System Postoperative Complications Risk Factors Internal medicine ABO blood group system medicine Humans Immunology and Allergy Pharmacology (medical) Prospective Studies ABO-incompatible transplantation Kidney transplantation Immunosuppression Therapy Blood type Transplantation business.industry Graft Survival Immunosuppression Plasmapheresis Middle Aged Prognosis medicine.disease Kidney Transplantation Titer Blood Group Incompatibility Immunology Kidney Failure Chronic Female business Immunosuppressive Agents Follow-Up Studies Glomerular Filtration Rate |
| Zdroj: | American Journal of Transplantation. 14:2807-2813 |
| ISSN: | 1600-6135 |
| DOI: | 10.1111/ajt.12920 |
| Popis: | 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 A1 to O (3), A1 to B (2), A2 to O (2), AB to A (2), AB to B (1), B to A1 (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. |
| Databáze: | OpenAIRE |
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