title: ABO incompatible high-titer renal transplantation without splenectomy or anti-CD20 treatment.
abstract: Most successful protocols for renal transplantation across ABO incompatible (ABOi) barriers have utilized splenectomy as part of the pre-conditioning process. We recently described successful ABOi transplantation using anti-CD20 monoclonal antibody in lieu of splenectomy. In the current study, we hypothesized that plasmapheresis (PP) and low dose CMV hyper-immunoglobulin (CMVIg) alone would be sufficient to achieve successful engraftment of ABOi kidneys. We describe four blood type incompatible patients who received live donor renal transplants from A1 (two patients), A2 (one patient), and B (one patient) donors. All patients started with antihuman globulin (AHG) phase titers of 64 or higher and were pre-conditioned with PP/CMVIg but not splenectomy or anti-CD20. All 4 patients underwent successful transplantation and have a mean current serum creatinine of 1.1 (range: 0.9-1.2). There were no episodes of antibody mediated rejection. Rapid allograft accommodation may limit the need for long-term antibody suppression provided by splenectomy or anti-CD20, thereby eliminating the added infectious risk of these modalities and removing another disincentive to ABOi transplantation.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Simpkins
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Warren
authors.forename: Karen E
authors.initials: KE
authors.lastname: King
authors.forename: R Sue
authors.initials: RS
authors.lastname: Shirey
authors.forename: Warren R
authors.initials: WR
authors.lastname: Maley
authors.forename: J Keith
authors.initials: JK
authors.lastname: Melancon
authors.forename: Matthew
authors.initials: M
authors.lastname: Cooper
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kozlowski
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000737:chemistry; D018951:Antigens, CD20 / Q000096:biosynthesis; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D005434:Flow Cytometry; D006084:Graft Rejection; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D008875:Middle Aged; D010956:Plasmapheresis; D013156:Splenectomy; D013997:Time Factors; D019172:Transplantation Conditioning
chemical_list: D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D018951:Antigens, CD20; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; C045781:cytomegalovirus-specific hyperimmune globulin; D003404:Creatinine