title: Desensitization with plasmapheresis and anti-Cd20 for ABO incompatible kidney transplantation from living donor: experience of a single center in Italy.
abstract: OBJECTIVE
  Blood group incompatibility in kidney transplants from a living donor can be successfully overcome by using various desensitization protocols: intravenous immunoglobulin, plasmapheresis (PP), immunoadsorption, and double filtration PP.
  
  
  METHODS
  From July 2010 to October 2013, we performed 10 ABO incompatible kidney transplantation (KT) procedures from a living donor. The desensitization protocol was based on rituximab and PP+cytomegalovirus immune globulin. All patients received induction with basiliximab, except 1 case treated with Thymoglobuline® (ATG) for the simultaneous presence of donor-specific antibody. Tacrolimus and mycophenolate mofetil were initiated at the time of desensitization and continued after the transplant.
  
  
  RESULTS
  After a mean follow-up of 11.6±10.4 months, all patients are alive with a functioning graft. The mean serum creatinine concentration at 1 month, 3 months, 6 months, and 1 year was 1.48±0.29, 1.47±0.18, 1.47±0.27, and 1.5±0.27 mg/dl. Three episodes of acute cellular rejection occurred in 2 patients. There was only 1 case of BK virus infection, treated with reduction of immunosuppressive therapy. The protocol biopsy specimens at 1, 3, and 6 months were C4d positive in the absence of acute rejection.
  
  
  CONCLUSIONS
  Desensitization with rituximab, PP, and anti-cytomegalovirus immune globulin allowed us to perform transplants from living donors to ABO incompatible recipients with excellent results and reduced costs.
authors.affiliation: Kidney and Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy. Electronic address: cs.cristinasilvestre@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Silvestre
authors.affiliation: Kidney and Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Furian
authors.affiliation: Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Marson
authors.affiliation: Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Tison
authors.affiliation: Institute of Pathology, A.O.U. of Padua, Padua, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Valente
authors.affiliation: Nephrology Unit, University Hospital of Padua, Padua, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Marchini
authors.affiliation: Nephrology Unit, University Hospital of Padua, Padua, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Rossi
authors.affiliation: Nephrology Unit, University Hospital of Padua, Padua, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Bonfante
authors.affiliation: Division of Nephrology, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Valerio
authors.affiliation: CORIT (Consortium for Research in Organ Transplantation), Padua, Italy; Clinical and Experimental Transplantation Immunology, University Hospital of Padua, Padua, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Cozzi
authors.affiliation: Kidney and Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Rigotti
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001787:Blood Group Incompatibility / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000517:prevention & control; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007558:Italy; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D000069283:Rituximab; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System; D058846:Antibodies, Monoclonal, Murine-Derived; D007136:Immunoglobulins; D007155:Immunologic Factors; D000069283:Rituximab