Kota Takahashi1,2, Kazuhide Saito3, Shiro Takahara4, Shohei Fuchinoue5, Takashi Yagisawa6, Atsushi Aikawa7, Yoshihiko Watarai8, Norio Yoshimura9, Kazunari Tanabe10, Kunio Morozumi11, Motohide Shimazu12. 1. Niigata Organ Transplant Foundation, Niigata, Japan. takahashi-kouta@image.ocn.ne.jp. 2. , 1-23-3 Kitaotsuka, Toshima-ku, Tokyo, 170-0004, Japan. takahashi-kouta@image.ocn.ne.jp. 3. Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan. 4. Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, Osaka, Japan. 5. Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan. 6. Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Tochigi, Japan. 7. Department of Nephrology, Toho University, Tokyo, Japan. 8. Transplant Surgery, Nagoya Daini Red Cross Hospital, Aichi, Japan. 9. Department of Organ Transplant and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. 10. Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. 11. Department of Nephrology, Masuko Memorial Hospital, Aichi, Japan. 12. Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
Abstract
BACKGROUND: Deceased organ donations are rare in Japan, with most kidney transplants performed from a limited number of living donors. Researchers have thus developed highly successful ABO-incompatible transplantation procedures, emphasizing preoperative desensitization and postoperative immunosuppression. A recent open-label, single-arm, multicenter clinical study prospectively examined the efficacy and safety of rituximab/mycophenolate mofetil desensitization in ABO-incompatible kidney transplantation without splenectomy. METHODS: Mycophenolate mofetil and low dose steroid were started 28 days pretransplant, followed by two doses of rituximab 375 mg/m2 at day -14 and day -1, and postoperative immunosuppression with tacrolimus or ciclosporin and basiliximab. The primary endpoint was the non-occurrence rate of acute antibody-mediated rejection. Patient survival and graft survival were monitored for 1 year posttransplant. RESULTS: Eighteen patients received rituximab and underwent ABO-incompatible kidney transplantation. CD19-positive peripheral B cell count decreased rapidly after the first rituximab infusion and recovered gradually after week 36. The desensitization protocol was tolerable, and most rituximab-related infusion reactions were mild. No anti-A/B antibody-mediated rejection occurred with this series. One patient developed anti-HLA antibody-mediated rejection (Banff 07 type II) on day 2, which was successfully managed. Patient and graft survival were both 100 % after 1 year. CONCLUSION: Our desensitization protocol was confirmed to be clinically effective and with acceptable toxicities for ABO-I-KTx (University Hospital Medical Information Network Registration Number: UMIN000006635).
BACKGROUND: Deceased organ donations are rare in Japan, with most kidney transplants performed from a limited number of living donors. Researchers have thus developed highly successful ABO-incompatible transplantation procedures, emphasizing preoperative desensitization and postoperative immunosuppression. A recent open-label, single-arm, multicenter clinical study prospectively examined the efficacy and safety of rituximab/mycophenolate mofetil desensitization in ABO-incompatible kidney transplantation without splenectomy. METHODS:Mycophenolate mofetil and low dose steroid were started 28 days pretransplant, followed by two doses of rituximab 375 mg/m2 at day -14 and day -1, and postoperative immunosuppression with tacrolimus or ciclosporin and basiliximab. The primary endpoint was the non-occurrence rate of acute antibody-mediated rejection. Patient survival and graft survival were monitored for 1 year posttransplant. RESULTS: Eighteen patients received rituximab and underwent ABO-incompatible kidney transplantation. CD19-positive peripheral B cell count decreased rapidly after the first rituximab infusion and recovered gradually after week 36. The desensitization protocol was tolerable, and most rituximab-related infusion reactions were mild. No anti-A/B antibody-mediated rejection occurred with this series. One patient developed anti-HLA antibody-mediated rejection (Banff 07 type II) on day 2, which was successfully managed. Patient and graft survival were both 100 % after 1 year. CONCLUSION: Our desensitization protocol was confirmed to be clinically effective and with acceptable toxicities for ABO-I-KTx (University Hospital Medical Information Network Registration Number: UMIN000006635).
Authors: G P Alexandre; J P Squifflet; M De Bruyère; D Latinne; R Reding; P Gianello; M Carlier; Y Pirson Journal: Transplant Proc Date: 1987-12 Impact factor: 1.066