Therapeutic plasma exchange for desensitization prior to transplantation in ABO-incompatible renal allografts.
BACKGROUND
Although there have been desensitization protocols used for ABO-incompatible (ABOi) renal transplants, there are a lack of studied protocols. Our center developed a preconditioning protocol that involved mycophenolic acid, therapeutic plasma exchange (TPE), anti-CD20 monoclonal antibody (rituximab), and intravenous immunoglobulin (IVIG) that allowed for ABOi renal transplantation.


METHODS
Ten patients in our institution with end-stage renal disease who were unable to procure ABO-compatible donor kidneys underwent treatment with this protocol (which included a uniform 5 TPE sessions) prior to an ABOi renal transplant. A retrospective chart review was performed on these patients and clinical endpoints including ABO antibody titers, serum creatinine, clinical complications, and graft performance were analyzed.


RESULTS
The median ABO antibody titers at presentation, after completion of the protocol, and after transplant for the patients were 32 (range, 2-128), 8 (range, 1-64), and 4 (range, 2-32), respectively. The mean serum creatinine at study conclusion was 1.45 +/- 1.04 mg/dl at an average of 262.20 days from transplant. There were four incidents of antibody-mediated rejection (AMR) and two incidents of delayed graft function (DGF). There was one incident of graft failure and no patient deaths.


CONCLUSIONS
The desensitization protocol used by our institution allowed for successful ABOi renal transplantation. Although there were incidents of AMR and DGF, the majority of the transplants resulted in viable grafts. A larger patient study group may be needed to fully evaluate the efficacy and safety of this protocol.
Sivakumaran
Praveen
P
Division of Transfusion Medicine, Pathology and Lab Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. praveen.sivakumaran@cshs.org
Vo
Ashley A
AA
Villicana
Rafael
R
Peng
Alice
A
Jordan
Stanley C
SC
Pepkowitz
Samuel H
SH
Klapper
Ellen B
EB
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility / Q000276:immunology / Q000628:therapy*; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007165:Immunosuppression Therapy; D007518:Isoantibodies / Q000097:blood; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D014184:Transplantation, Homologous
D000017:ABO Blood-Group System; D007518:Isoantibodies; D003404:Creatinine