ABO incompatible renal transplantation in an HIV-seropositive patient.
To date, there have been no reports of successful ABO blood group incompatible renal transplantation in HIV patients. We describe a case of a 47-year-old African American man with end-stage renal disease secondary to HIV-induced nephropathy who underwent a live unrelated (spouse) donor ABO blood group incompatible transplant using an intravenous immunoglobulin/plasmapheresis preconditioning regimen with interleukin-2 receptor antagonist induction along with tacrolimus and mycophenolate mofetil maintenance. The postoperative course was complicated by two acute cellular rejection (Banff Ia) episodes that were successfully managed with corticosteroid boluses and the addition of corticosteroids to maintenance immunosuppression. Antibody-mediated rejection was not observed on biopsy. The patient reached a serum creatinine nadir of 2.0 mg/dL on postoperative day 20, which has now been maintained for 170 days. His current CD4 count was 410 cells/microL.
Campara
Maya
M
Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA.
West-Thielke
Patricia
P
Thielke
James
J
Ommert
Thuy
T
Oberholzer
Jose
J
Benedetti
Enrico
E
Kaplan
Bruce
B
D000017:ABO Blood-Group System; D016263:AIDS-Associated Nephropathy / Q000097:blood / Q000276:immunology / Q000601:surgery* / Q000821:virology; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001787:Blood Group Incompatibility; D003888:Desensitization, Immunologic / Q000379:methods; D006084:Graft Rejection / Q000517:prevention & control; D006679:HIV Seropositivity / Q000097:blood / Q000150:complications* / Q000821:virology; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000097:blood / Q000276:immunology / Q000601:surgery* / Q000821:virology; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents