ABO-incompatible transplantation: less may be more.
Many have reported success with ABO-incompatible kidney transplantation using B-cell ablative therapies such as anti-CD20 and splenectomy. However, splenectomy and anti-CD20 is associated with an increased risk of infection. We show how ABO-incompatible kidney transplants can be accomplished with a low risk of antibody-mediated rejection and graft loss using plasmapheresis preconditioning, low-dose intravenous immunoglobulin, and standard maintenance immunosuppression. The mean follow up for our cohort of 53 patients is 2 years. The mean creatinine clearance at 1 and 3 years is 58 mL/min and 63 mL/min, predicting excellent long-term function. Only long-term follow up of these patients will render definitive answers, however, these data demonstrate that ABO-incompatible kidney transplantation increases the donor pool by providing live donor kidneys that function promptly with minimal risk of early loss. This can be accomplished with a modest, brief escalation of immunosuppression and at a lower cost to the health care system than maintaining the patient on dialysis.
Montgomery
Robert A
RA
Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. rmonty@jhmi.edu.us
Locke
Jayme E
JE
D000017:ABO Blood-Group System; D000328:Adult; D000368:Aged; D018951:Antigens, CD20 / Q000737:chemistry; D001402:B-Lymphocytes / Q000378:metabolism; D001787:Blood Group Incompatibility; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D013156:Splenectomy
D000017:ABO Blood-Group System; D018951:Antigens, CD20; D007166:Immunosuppressive Agents; D003404:Creatinine