BACKGROUND: Given the scarcity of cadaveric organs, efforts are intensifying to increase the availability of living donors. The current study assessed the feasibility of using ABO-incompatible living-donor kidneys to expand the donor pool. METHODS: The authors performed 18 ABO-incompatible living-donor kidney transplants between May 1999 and April 2001. Ten patients received living-donor kidneys from A2 and eight patients received kidneys from non-A2 blood group donors. Immunosuppression consisted of Thymoglobulin antibody induction, tacrolimus, mycophenolate mofetil, and prednisone. Eight non-A2 and two A2 kidney recipients also received a pretransplant conditioning regimen of four plasmapheresis treatments followed by intravenous immunoglobulin and splenectomy at the time of transplantation. Antidonor blood group antibody titer was measured at baseline, pretransplant, at 1- to 3-month and 1-year follow-up, and at the time of diagnosis of antibody-mediated rejection. RESULTS: No hyperacute rejection episodes occurred. One-year graft and patient survival rates in the 18 ABO-incompatible recipients were only slightly lower than those of 81 patients who received ABO-compatible kidney transplants during the same period (89% vs. 96% and 94% vs. 99%, respectively). Glomerular filtration rate and serum creatinine levels did not differ between the groups. Antibody-mediated rejection occurred in 28% of ABO-incompatible recipients, and was reversible with plasmapheresis, intravenous immunoglobulin, and increasing immunosuppression in all patients except one. CONCLUSIONS: ABO-incompatible living donor kidney transplants can achieve an acceptable 1-year graft survival rate using an immunosuppressive regimen consisting of Thymoglobulin induction, tacrolimus, mycophenolate mofetil, and prednisone combined with pretransplant plasmapheresis, intravenous immunoglobulin, and splenectomy.
BACKGROUND: Given the scarcity of cadaveric organs, efforts are intensifying to increase the availability of living donors. The current study assessed the feasibility of using ABO-incompatible living-donor kidneys to expand the donor pool. METHODS: The authors performed 18 ABO-incompatible living-donor kidney transplants between May 1999 and April 2001. Ten patients received living-donor kidneys from A2 and eight patients received kidneys from non-A2 blood group donors. Immunosuppression consisted of Thymoglobulin antibody induction, tacrolimus, mycophenolate mofetil, and prednisone. Eight non-A2 and two A2 kidney recipients also received a pretransplant conditioning regimen of four plasmapheresis treatments followed by intravenous immunoglobulin and splenectomy at the time of transplantation. Antidonor blood group antibody titer was measured at baseline, pretransplant, at 1- to 3-month and 1-year follow-up, and at the time of diagnosis of antibody-mediated rejection. RESULTS: No hyperacute rejection episodes occurred. One-year graft and patient survival rates in the 18 ABO-incompatible recipients were only slightly lower than those of 81 patients who received ABO-compatible kidney transplants during the same period (89% vs. 96% and 94% vs. 99%, respectively). Glomerular filtration rate and serum creatinine levels did not differ between the groups. Antibody-mediated rejection occurred in 28% of ABO-incompatible recipients, and was reversible with plasmapheresis, intravenous immunoglobulin, and increasing immunosuppression in all patients except one. CONCLUSIONS:ABO-incompatible living donor kidney transplants can achieve an acceptable 1-year graft survival rate using an immunosuppressive regimen consisting of Thymoglobulin induction, tacrolimus, mycophenolate mofetil, and prednisone combined with pretransplant plasmapheresis, intravenous immunoglobulin, and splenectomy.
Authors: Mark Haas; Dorry L Segev; Lorraine C Racusen; Serena M Bagnasco; Jayme E Locke; Daniel S Warren; Christopher E Simpkins; Diane Lepley; Karen E King; Edward S Kraus; Robert A Montgomery Journal: J Am Soc Nephrol Date: 2008-09-05 Impact factor: 10.121
Authors: Margaux N Mustian; Robert M Cannon; Paul A MacLennan; Rhiannon D Reed; Brittany A Shelton; Deanna M McWilliams; Mark H Deierhoi; Jayme E Locke Journal: J Am Coll Surg Date: 2018-01-05 Impact factor: 6.113
Authors: John R Montgomery; Jonathan C Berger; Daniel S Warren; Nathan T James; Robert A Montgomery; Dorry L Segev Journal: Transplantation Date: 2012-03-27 Impact factor: 4.939
Authors: Paulo N Martins; Margaux N Mustian; Paul A MacLennan; Jorge A Ortiz; Mohamed Akoad; Juan Carlos Caicedo; Gabriel J Echeverri; Stephen H Gray; Reynold I Lopez-Soler; Ganesh Gunasekaran; Beau Kelly; Constance M Mobley; Sylvester M Black; Carlos Esquivel; Jayme E Locke Journal: Am J Transplant Date: 2018-03-31 Impact factor: 8.086
Authors: Armin D Goralczyk; Aiman Obed; Andreas Schnitzbauer; Axel Doenecke; Tung Yu Tsui; Marcus N Scherer; Giuliano Ramadori; Thomas Lorf Journal: J Transplant Date: 2010-02-03