Successful living donor renal transplantation despite ABO incompatibility and a positive crossmatch.
Potential live kidney donors have been rejected when the prospective recipients are blood type or crossmatch incompatible. By utilizing plasmapheresis combined with intravenous immune globulin (PP/IVIg) prior to surgery, donor-specific antibodies against blood group or human leukocyte antigens (HLA) have been removed, thereby allowing successful renal transplantation. A 26-yr-old male with a panel reactive antibody level of 100% and repeated positive crossmatches against deceased donor kidney offers, including zero HLA mismatched donors, successfully underwent ABO-incompatible kidney transplantation from his HLA-identical but nevertheless crossmatch-incompatible sister. The initial anti-A blood group isoagglutinin titers were 128, 256, and 1024 at room temperature, 37 degrees C, and 37 degrees C anti-IgG enhanced, respectively. With an individualized PP/IVIg regimen based on donor-specific antibody titer, however, the relevant antibodies were adequately reduced and hyperacute rejection avoided. Subsequent antibody-mediated rejection, likely directed against a minor histocompatibility antigen, was diagnosed on postoperative day 7 and successfully treated. Neither ABO, or crossmatch incompatibility, or both in combination prohibit kidney transplantation.
Kayler
Liise K
LK
Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA. liise.kayler@yahoo.com
Colombe
Beth
B
Farber
John L
JL
Lacava
Deborah
D
Dafoe
Donald C
DC
Burke
James F
JF
Francos
George C
GC
Ratner
Lloyd E
LE
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male
D000017:ABO Blood-Group System