Jelena Stojanovic1, Anna Adamusiak, Nicos Kessaris, Pankaj Chandak, Zubir Ahmed, Neil J Sebire, Grainne Walsh, Helen E Jones, Stephen D Marks, Nizam Mamode. 1. 1 Department of Pediatric Nephrology and Transplantation at Evelina London Children's Hospital, London, United Kingdom. 2 Department of Transplantation at Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom. 3 Department of Pediatric Nephrology and Transplantation at Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom. 4 Department of Histopathology at Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
Abstract
BACKGROUND: Blood group incompatible transplantation (ABOi) in children is rare as pretransplant conditioning remains challenging and concerns persist about the potential increased risk of rejection. METHODS: We describe the results of 11 ABOi pediatric renal transplant recipients in the 2 largest centers in the United Kingdom, sharing the same tailored desensitization protocol. Patients with pretransplant titers of 1 or more in 8 received rituximab 1 month before transplant; tacrolimus and mycophenolate mofetil were started 1 week before surgery. Antibody removal was performed to reduce titers to 1 or less in 8 on the day of the operation. No routine postoperative antibody removal was performed. RESULTS: Death-censored graft survival at last follow-up was 100% in the ABOi and 98% in 50 compatible pediatric transplants. One patient developed grade 2A rejection successfully treated with antithymocyte globulin. Another patient had a titer rise of 2 dilutions treated with 1 immunoadsorption session. There was no histological evidence of rejection in the other 9 patients. One patient developed cytomegalovirus and BK and 2 others EBV and BK viremia. CONCLUSIONS: Tailored desensitization in pediatric blood group incompatible kidney transplantation results in excellent outcomes with graft survival and rejection rates comparable with compatible transplants.
BACKGROUND: Blood group incompatible transplantation (ABOi) in children is rare as pretransplant conditioning remains challenging and concerns persist about the potential increased risk of rejection. METHODS: We describe the results of 11 ABOi pediatric renal transplant recipients in the 2 largest centers in the United Kingdom, sharing the same tailored desensitization protocol. Patients with pretransplant titers of 1 or more in 8 received rituximab 1 month before transplant; tacrolimus and mycophenolate mofetil were started 1 week before surgery. Antibody removal was performed to reduce titers to 1 or less in 8 on the day of the operation. No routine postoperative antibody removal was performed. RESULTS: Death-censored graft survival at last follow-up was 100% in the ABOi and 98% in 50 compatible pediatric transplants. One patient developed grade 2A rejection successfully treated with antithymocyte globulin. Another patient had a titer rise of 2 dilutions treated with 1 immunoadsorption session. There was no histological evidence of rejection in the other 9 patients. One patient developed cytomegalovirus and BK and 2 others EBV and BK viremia. CONCLUSIONS: Tailored desensitization in pediatric blood group incompatible kidney transplantation results in excellent outcomes with graft survival and rejection rates comparable with compatible transplants.
Authors: Eun Yee Hew; Nicos Kessaris; Jelena Stojanovic; Helen Jones; Martin Christian; Anusha Edwards; David V Milford; Milos Ognjanovic; Mohan Shenoy; Richard J Baker; Stephen D Marks Journal: Pediatr Nephrol Date: 2022-06-13 Impact factor: 3.714
Authors: Anna M Adamusiak; Jelena Stojanovic; Olivia Shaw; Robert Vaughan; Neil J Sebire; Martin Drage; Nicos Kessaris; Stephen D Marks; Nizam Mamode Journal: Pediatr Nephrol Date: 2016-09-01 Impact factor: 3.714