Acute antibody-mediated rejection after ABO-incompatible kidney transplantation treated successfully with antigen-specific immunoadsorption.
ABO-incompatible kidney transplantation is possible after pre-treatment with rituximab, intravenous immunoglobulin and basiliximab combined with tacrolimus, mycophenolate mofetil and prednisolone. We report on the first patient treated with this protocol who developed acute antibody-mediated rejection (Banff grade II with IgG deposits) caused by ABO antibodies (anti-B). Anti-rejection treatment with anti-B-specific immunoadsorption, intravenous immunoglobulin and methylprednisolone efficiently cleared deposited IgG from the kidney allograft and re-established normal kidney function. We suggest that ABO-incompatible kidney transplantation complicated by acute antibody-mediated rejection, caused by ABO antibodies, may successfully be treated with this regime.
Just
Søren Andreas
SA
Department of Clinical Immunology, Odense University Hospital, Odense, Denmark. saj@dadlnet.dk
Marcussen
Niels
N
Sprogøe
Ulrik
U
Koefoed-Nielsen
Pernille
P
Bistrup
Claus
C
D000017:ABO Blood-Group System / Q000276:immunology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000276:immunology* / Q000517:prevention & control*; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007163:Immunosorbent Techniques; D007668:Kidney / Q000276:immunology; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged
D000017:ABO Blood-Group System; D005938:Glucocorticoids; D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; D008775:Methylprednisolone