Isoagglutinin titre adsorption: breaking the barrier in major AB0-incompatible organ transplantation.
Blood group AB0-incompatible live donor (LD) renal transplantation may provide a significant source of organs. AB0-incompatible LD renal transplantation can be accomplished using specific anti-A/B antibody (Ab) immunoadsorption (IA) and anti-CD20 monoclonal Ab (Rituximab) treatment. One dose of anti-CD20 mAb (rituximab, 375 mg/m(2)) is given for weeks pre-operatively. Recipients are pre-treated with 3-5 sessions of immunoadsorption, using A or B carbohydrate antigen specific columns, until their anti-A1/B RBC panel indirect antiglobulin test (IAT) titres are <8. Polyclonal immunoglobulins are applied four days before transplantation. Recipients receive preoperative mycophenolic acid, steroids/tacrolimus therapy. No splenectomy was performed. Postoperative IA is applied if RBC panel indirect antiglobulin test (IAT) titres are >8. Postoperative renal biopsies may yield positive C4d staining in peritubular capillaries as sign of humoral immune activation but the clinical course is favourable if IAT titres can be kept below 8 within the first weeks after transplantation. This protocol has excellent short-term and long-term graft survival as well as function although recipient anti-A/B titres after transplantation return to pre-surgical levels within months after transplantation.
Wilde
Benjamin
B
Department of Nephrology, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
Pietruck
Frank
F
Kribben
Andreas
A
Witzke
Oliver
O
D000017:ABO Blood-Group System / Q000276:immunology*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D001402:B-Lymphocytes / Q000276:immunology*; D001706:Biopsy; D001787:Blood Group Incompatibility / Q000276:immunology*; D003404:Creatinine / Q000097:blood; D006085:Graft Survival / Q000276:immunology*; D006388:Hemagglutinins / Q000276:immunology*; D006801:Humans; D056724:Immunity, Humoral; D007155:Immunologic Factors / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D019520:Living Donors; D000069283:Rituximab
D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D006388:Hemagglutinins; D007155:Immunologic Factors; D000069283:Rituximab; D003404:Creatinine