title: Initial experience with ABO-incompatible live donor renal transplantation.
abstract: The serious shortage of cadaveric organs has prompted the development of ABO-incompatible live donor renal transplantation. We report our experience of the initial two live donor ABO incompatible renal transplants at our hospital. The first patient was a 55-year-old type A female who received a kidney from her AB type husband. The second patient was a 27-year-old type O male who received renal transplantation from his type A father. Preconditioning immunosuppressive therapy in the two patients with tacrolimus, mycophenolate mofetil and methylprednisolone was started 7 days before transplantation. During the period of preconditioning, double filtration plasmapheresis (DFPP) was employed to remove anti-A and -B antibodies. Laparoscopic splenectomy and renal transplantation were performed after the anti-donor ABO antibodies were reduced to a titer of 1:4. Rituximab, a humanized monoclonal anti-CD20 antibody, was administered to the second patient due to a rebound in the anti-A antibody titer during the preconditioning period. Under a tacrolimus-based immunosuppressive regimen, both patients recovered very well without any evidence of rejection. Serum creatinine levels were 1.0 and 1.4 mg/dL at 6 and 3 months after transplantation, respectively. These cases illustrate that with new immunosuppressive agents, DFPP and splenectomy, ABO-incompatible renal transplantation can be successfully conducted in end-stage renal disease patients whose only available live donors are blood group incompatible.
authors.affiliation: Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Meng-Kun
authors.initials: MK
authors.lastname: Tsai
authors.forename: Ming-Hsiou
authors.initials: MH
authors.lastname: Wu
authors.forename: Shyh-Chyl
authors.initials: SC
authors.lastname: Lo
authors.forename: I-Rue
authors.initials: IR
authors.lastname: Lai
authors.forename: Sen-Chang
authors.initials: SC
authors.lastname: Yu
authors.forename: Ray-Hwang
authors.initials: RH
authors.lastname: Yuan
authors.forename: Po-Huang
authors.initials: PH
authors.lastname: Lee
mesh_terms: D000017:ABO Blood-Group System / Q000097:blood*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D001787:Blood Group Incompatibility; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000601:surgery*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D000069283:Rituximab; D013156:Splenectomy; D016559:Tacrolimus / Q000627:therapeutic use; D009927:Tissue and Organ Procurement; D019172:Transplantation Conditioning; D014181:Transplantation Immunology
chemical_list: D000017:ABO Blood-Group System; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008775:Methylprednisolone