title: A Comparison of splenectomy versus intensive posttransplant antidonor blood group antibody monitoring without splenectomy in ABO-incompatible kidney transplantation.
abstract: BACKGROUND
  Although most protocols for ABO-incompatible kidney transplantation have employed splenectomy, its utility is unproven. The aim of the current study was to compare the outcomes of ABO-incompatible living donor kidney transplantation with splenectomy versus a protocol involving intensive posttransplant antibody monitoring to maintain low levels of antiblood group antibody.
  
  
  METHODS
  We retrospectively studied all ABO-incompatible living donor kidney transplants at our institution between September 1999 and November 2004 (n=34). Prior to May 2003, all patients were included in a protocol involving pretransplant plasmapheresis and splenectomy at the time of transplant (n=23). After May 2003, splenectomy was not performed and a protocol that involved pretransplant anti-CD20 antibody and a more intensive posttransplant plasmapheresis regiment aimed at maintaining low levels of antiblood group antibody during the first 2 weeks following transplantation was utilized (n=11).
  
  
  RESULTS
  Patient and graft survival was similar in the two groups. Humoral rejection occurred in 18% nonsplenectomized and 30% of splenectomized patients (P=0.68). Humoral rejection correlated with the baseline antibody titer in both groups. Individuals with elevated baseline antibody titer (> or =1:256) appear to be at high risk for humoral rejection regardless of protocol used. Antiblood group antibody levels 3 and 12 months after transplantation were similar in both groups.
  
  
  CONCLUSIONS
  Splenectomy is not essential for successful ABO-incompatible kidney transplantation, although individuals with high baseline antidonor blood group antibody titers are at high risk for humoral rejection. The use of intensive posttransplant monitoring may help prevent antibody-mediated graft damage.
authors.affiliation: Department of Nephrology and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. gloor.james@mayo.edu
authors.forename: James M
authors.initials: JM
authors.lastname: Gloor
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Lager
authors.forename: Mary E
authors.initials: ME
authors.lastname: Fidler
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Grande
authors.forename: S Breanndan
authors.initials: SB
authors.lastname: Moore
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
authors.forename: Walter K
authors.initials: WK
authors.lastname: Kremers
authors.forename: Mark D
authors.initials: MD
authors.lastname: Stegall
mesh_terms: D000017:ABO Blood-Group System; D001787:Blood Group Incompatibility / Q000601:surgery*; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D011183:Postoperative Complications / Q000276:immunology / Q000601:surgery; D012189:Retrospective Studies; D013156:Splenectomy; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents