title: Tailored desensitization strategies in ABO blood group antibody incompatible renal transplantation.
abstract: ABO blood group incompatible renal transplantation, using desensitization procedures, is an effective strategy. Efforts have been made to reduce desensitization: these are usually applied to all patients indiscriminately. The Guy's Hospital ABO blood group incompatible desensitization regimen uses a tiered approach, tailoring strategy according to initial antibody titres. Sixty-two ABO blood group incompatible living donor transplant recipients were compared with 167 recipients of blood group compatible living donor renal transplants. There were no statistically significant differences in allograft survival rates at 1 or 3 years post-transplant, rejection in the first year post-transplant or renal function in the first 3 years post-transplant. There was a higher rate of death in ABO blood group incompatible transplant recipients - this could be associated with differences in age and HLA mismatch between the two groups. Four ABO blood group incompatible patients experienced antibody-mediated rejection (no episode was associated with a rise in ABO blood group antibodies). Of the patients who received no desensitization, or rituximab alone, none has experienced antibody mediated rejection or experienced allograft loss. Tailoring the use of desensitization in ABO blood group incompatible renal transplantation according to initial ABO blood group antibody titres led to comparable results to blood group compatible transplantation.
authors.affiliation: Renal and Transplant Department, Guy's and St Thomas' NHS Foundation Trust, London, UK; Division of Transplantation Immunology and Mucosal Biology, King's College London, London, UK.
authors.forename: A Nicholas R
authors.initials: AN
authors.lastname: Barnett
authors.forename: Miriam
authors.initials: M
authors.lastname: Manook
authors.forename: Myura
authors.initials: M
authors.lastname: Nagendran
authors.forename: Shivakumar
authors.initials: S
authors.lastname: Kenchayikoppad
authors.forename: Robert
authors.initials: R
authors.lastname: Vaughan
authors.forename: Anthony
authors.initials: A
authors.lastname: Dorling
authors.forename: Vassilis G
authors.initials: VG
authors.lastname: Hadjianastassiou
authors.forename: Nizam
authors.initials: N
authors.lastname: Mamode
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000327:Adsorption; D000328:Adult; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001787:Blood Group Incompatibility / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival; D015234:HLA-A Antigens / Q000276:immunology; D015235:HLA-B Antigens / Q000276:immunology; D006684:HLA-DR Antigens / Q000276:immunology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens; D016756:Immunoglobulins, Intravenous; D000074323:Alemtuzumab; D000069283:Rituximab
keywords: ABO incompatibility; immunoadsorption; kidney transplantation; monoclonal antibodies; plasmapheresis