title: Therapeutic plasma exchange for desensitization prior to transplantation in ABO-incompatible renal allografts.
abstract: 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.
authors: Division of Transfusion Medicine, Pathology and Lab Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. praveen.sivakumaran@cshs.org
authors: Praveen
authors: P
authors: Sivakumaran
authors: Ashley A
authors: AA
authors: Vo
authors: Rafael
authors: R
authors: Villicana
authors: Alice
authors: A
authors: Peng
authors: Stanley C
authors: SC
authors: Jordan
authors: Samuel H
authors: SH
authors: Pepkowitz
authors: Ellen B
authors: EB
authors: Klapper
mesh_terms: 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
chemical_list: D000017:ABO Blood-Group System; D007518:Isoantibodies; D003404:Creatinine