Plasmapheresis, CMV hyperimmune globulin, and anti-CD20 allow ABO-incompatible renal transplantation without splenectomy.
The majority of preconditioning protocols developed to allow ABO-incompatible (ABOi) renal transplantation include concurrent splenectomy as a prerequisite to successful engraftment. Our center has developed a preconditioning protocol that includes plasmapheresis (PP), low-dose CMV hyperimmune globulin (CMVIg), and anti-CD20 monoclonal antibody (rituximab) to allow ABOi renal transplantation without splenectomy. Our initial experience has included treatment of six recipients and successful transplantation from blood group A(1), A(2), and group B living donors. Mean (+/- SD) serum creatinine was 1.3 +/- 0.1 mg/dL among the six recipients and no episodes of antibody-mediated rejection (AMR) occurred at a median follow-up of 12 months. ABO antibody titers have remained below pretreatment levels. The absence of AMR and stable allograft function in this series show the potential of this preconditioning protocol to increase ABOi renal transplantation. The use of rituximab, allowing avoidance of splenectomy, may further remove one of the significant disincentives to ABOi transplantation, and eliminate the risk of post-splenectomy infections.
Sonnenday
Christopher J
CJ
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Warren
Daniel S
DS
Cooper
Mathew
M
Samaniego
Milagros
M
Haas
Mark
M
King
Karen E
KE
Shirey
R Sue
RS
Simpkins
Christopher E
CE
Montgomery
Robert A
RA
D000017:ABO Blood-Group System; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000737:chemistry / Q000494:pharmacology; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000737:chemistry* / Q000276:immunology; D001706:Biopsy; D001787:Blood Group Incompatibility / Q000628:therapy; D003404:Creatinine / Q000097:blood; D003587:Cytomegalovirus / Q000235:genetics*; D005260:Female; D005916:Globulins / Q000737:chemistry; D005919:Glomerular Filtration Rate; D006801:Humans; D007136:Immunoglobulins / Q000737:chemistry*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D000069283:Rituximab; D013154:Spleen / Q000166:cytology / Q000502:physiology; D013156:Splenectomy / Q000379:methods*; D013997:Time Factors; D019172:Transplantation Conditioning; D014181:Transplantation Immunology
D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D005916:Globulins; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003404:Creatinine