title: ABO-incompatible pediatric kidney transplantation in a single-center trial.
abstract: We have performed ten pediatric kidney transplantations from living-related ABO-incompatible donors. All patients underwent preoperative plasmapheresis with or without immunoadsorption to reduce isoagglutinin. Primary immunosuppression consisted of methyl-prednisolone, cyclosporin or tacrolimus, azathioprine, anti-lymphocyte globulin, and/or deoxyspergualin. At transplantation splenectomy was simultaneously performed in all patients. Median follow-up is 65 months (range 4-95 months). The patient and graft survival rates are 100% to date. Post-transplantation isoagglutinin titers did not increase more than 1:32, except for 1 patient, without uncontrollable vascular rejection episodes. Despite the heavy immunosuppressive regimen, cytomegalovirus infection occurred in only three patients, who were successfully treated with ganciclovir and cytomegalovirus high-titer gamma globulin. Our small series clearly shows that the preoperative reduction of isoagglutinin, splenectomy, and strict immunosuppressive therapy lead to successful long-term results in children.
authors.affiliation: Department of Pediatric Nephrology, Tokyo Women's Medical College, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ohta
authors.forename: H
authors.initials: H
authors.lastname: Kawaguchi
authors.forename: M
authors.initials: M
authors.lastname: Hattori
authors.forename: K
authors.initials: K
authors.lastname: Takahashi
authors.forename: H
authors.initials: H
authors.lastname: Nagafuchi
authors.forename: Y
authors.initials: Y
authors.lastname: Akioka
authors.forename: W
authors.initials: W
authors.lastname: Mizushima
authors.forename: N
authors.initials: N
authors.lastname: Ishikawa
authors.forename: K
authors.initials: K
authors.lastname: Tanabe
authors.forename: H
authors.initials: H
authors.lastname: Toma
authors.forename: K
authors.initials: K
authors.lastname: Takahashi
authors.forename: K
authors.initials: K
authors.lastname: Ota
authors.forename: K
authors.initials: K
authors.lastname: Ito
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D001787:Blood Group Incompatibility; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D011183:Postoperative Complications
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents