ABO incompatible living renal transplantation with a steroid sparing protocol.
BACKGROUND
ABO incompatible (ABOi) live-donor renal transplantation is a successful and accepted form of treatment for patients with renal failure. Although there is significant controversy as to how antiblood group antibodies should be removed and their resynthesis prevented, subsequent immunosuppressive regimes have all involved steroids. We and other groups have successfully used steroid sparing regimes for conventional ABO compatible transplantation and this study describes the use of our steroid sparing protocol in ABOi transplantation.


METHODS
We have transplanted 10 ABOi patients using 1 week of steroids (prednisolone 1 mg/kg for 4 days, 0.5 mg/kg for 3 days and then stopped), tacrolimus and mycophenolate mofetil. Steroids were reintroduced in the event of rejection.


RESULTS
Patient- and allograft-survival 1 year posttransplantation is 100%. Three patients experienced antibody-mediated rejection within 2 weeks of transplantation, which was successfully reversed. There has been no late rejection. Allograft function was similar to our live-donor ABO compatible transplant patients receiving a similar steroid sparing regime (12-month mean creatinine 131+/-15 micromol/L vs. 138+/-48 micromol/L; mean CrCl 63.2+/-22 mL/min vs. 56.7+/-20 mL/min).


CONCLUSIONS
This study shows that ABOi live-donor transplantation can be successfully accomplished using a steroid-sparing protocol.
West London Renal and Transplant Centre, Imperial College Kidney and Transplant Institute, Hammersmith Hospital, Du Cane Road, London, United Kingdom. jackwg@doctors.org.uk
Jack
J
Galliford
Rawya
R
Charif
Ka Kit
KK
Chan
Marina
M
Loucaidou
Tom
T
Cairns
H Terence
HT
Cook
Anthony
A
Dorling
Nadey
N
Hakim
Adam
A
McLean
Vassilios
V
Papalois
Ranjan
R
Malde
Fiona
F
Regan
Martin
M
Redman
Anthony N
AN
Warrens
David
D
Taube
D000017:ABO Blood-Group System; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D001787:Blood Group Incompatibility; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D018579:Patient Selection; D011239:Prednisolone / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use
D000017:ABO Blood-Group System; D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus