[AB0-incompatible kidney transplantation--case 13/2009].
PATIENT HISTORY AND CLINICAL FINDINGS: A 49-year old patient with chronic kidney disease was referred for evaluation of living donor kidney transplantation from his spouse in a blood group incompatible setting.


METHODS
Patient blood group was 0, donor blood group was A, subtype A. recipient isoagglutinin titer against donor erythrocytes was 1:64. Crossmatch (CDC) and antibody screening were negative. There were no contraindications for living donor kidney transplantation from donor and recipient side.


METHODS
For AB0-incompatible living donor kidney transplantation, recipient preconditioning using rituximab and selective immunoadsorption was initiated to obtain reduction of isoagglutinin titers < or = 1:4. Transplantation was performed without complications. With only moderate increases in titer, no immunoadsorption was required postoperatively. Monitoring of isoagglutinin titers was discontinued after day 14, since increasing titers do not result in organ loss any more (accomodation). 18 months after transplantation, renal function is excellent under corticosteroid-free maintenance immunosuppression.


CONCLUSIONS
Recipient preconditioning nowadays allows successful blood group incompatible kidney transplantation in most cases, increasing the number of patients eligible for living donor kidney transplantation by up to 20%. No intensified maintenance immunosuppression is required and renal allograft function after AB0-incompatible transplantation is comparable to blood group compatible living donor kidney transplantation.
Guthoff
Martina
M
Universitätsklinikum Tübingen, Medizinische Klinik, Abteilung für Endokrinologie, Diabetes, Nephrologie, Angiologie und Klinische Chemie.
Wernet
Dorothee
D
Steurer
Wolfgang
W
Heyne
Nils
N
D000017:ABO Blood-Group System / Q000097:blood*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D001787:Blood Group Incompatibility / Q000097:blood*; D001788:Blood Grouping and Crossmatching; D004912:Erythrocytes / Q000276:immunology; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage; D007163:Immunosorbent Techniques; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab