BACKGROUND: Historically, ABO-incompatible kidney transplantations have only been undertaken after splenectomy and unspecific plasmapheresis and with quadruple drug immunosuppression plus B-cell specific drugs. We have evaluated a protocol for ABO-incompatible kidney transplantation without splenectomy using antigen-specific immunoadsorption, rituximab, and a conventional triple-drug immunosuppressive regimen. METHODS: The protocol called for a 10-day pretransplant conditioning period starting with one dosage of rituximab and followed by full dose tacrolimus, mycophenolate mofetil, and prednisolone. Antigen-specific immunoadsorption was performed on pretransplant days -6, -5, -4, and -1. After the last session, 0.5 g/kg of intravenous immunoglobulin was administered. Postoperatively, three more apheresis sessions were given every third day. Furthermore, if there was a significant increase in the antibody titers, extra sessions were considered. RESULTS: Four patients have received transplants with this protocol. The donor-recipient blood groups were A2/O, B/O, B/A, and A1/O. The ABO-antibodies were readily removed by the antigen-specific immunoadsorption and were kept at a low level posttransplantation by further adsorptions. There were no side effects, and all patients have normal renal-transplant function. CONCLUSIONS: We conclude that after one infusion each of rituximab and intravenous immunoglobulin and antigen-specific immunoadsorption, blood-group-incompatible renal transplantations can be performed with standard immunosuppression and without splenectomy.
BACKGROUND: Historically, ABO-incompatible kidney transplantations have only been undertaken after splenectomy and unspecific plasmapheresis and with quadruple drug immunosuppression plus B-cell specific drugs. We have evaluated a protocol for ABO-incompatible kidney transplantation without splenectomy using antigen-specific immunoadsorption, rituximab, and a conventional triple-drug immunosuppressive regimen. METHODS: The protocol called for a 10-day pretransplant conditioning period starting with one dosage of rituximab and followed by full dose tacrolimus, mycophenolate mofetil, and prednisolone. Antigen-specific immunoadsorption was performed on pretransplant days -6, -5, -4, and -1. After the last session, 0.5 g/kg of intravenous immunoglobulin was administered. Postoperatively, three more apheresis sessions were given every third day. Furthermore, if there was a significant increase in the antibody titers, extra sessions were considered. RESULTS: Four patients have received transplants with this protocol. The donor-recipient blood groups were A2/O, B/O, B/A, and A1/O. The ABO-antibodies were readily removed by the antigen-specific immunoadsorption and were kept at a low level posttransplantation by further adsorptions. There were no side effects, and all patients have normal renal-transplant function. CONCLUSIONS: We conclude that after one infusion each of rituximab and intravenous immunoglobulin and antigen-specific immunoadsorption, blood-group-incompatible renal transplantations can be performed with standard immunosuppression and without splenectomy.
Authors: Karolin Thiel; Christian Thiel; Martin Schenk; Ruth Ladurner; Silvio Nadalin; Nils Heyne; Alfred Königsrainer; Wolfgang Steurer Journal: Wien Klin Wochenschr Date: 2011-11-30 Impact factor: 1.704
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: Michael Haidinger; Sabine Schmaldienst; Günther Körmöczi; Heinz Regele; Afschin Soleiman; Dieter Schwartz; Kurt Derfler; Rudolf Steininger; Ferdinand Mühlbacher; Georg A Böhmig Journal: Wien Klin Wochenschr Date: 2009 Impact factor: 1.704
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