title: Clinical outcomes of ABO-incompatible kidney transplant with rituximab and double-filtration plasmapheresis.
abstract: OBJECTIVE
  The best treatment for end-stage renal disease is kidney transplant, but the shortage of donor organs has caused long waiting times for an appropriate organ allograft. The use of ABO-incompatible kidney transplant can be a valuable option to expand the donor pool. The purpose of the present study was to evaluate 13 patients who had successful ABO-incompatible kidney transplant with double-filtration plasmapheresis and rituximab.
  
  
  METHODS
  From January 2011 to August 2012, there were 13 patients who had ABO-incompatible kidney transplant. Antibody titers were monitored during preconditioning and after transplant. Preconditioning protocol included rituximab, mycophenolate mofetil, tacrolimus, corticosteroids, double-filtration plasmapheresis, and intravenous immunoglobulin.
  
  
  RESULTS
  There were no episodes of acute T-cell or antibody-mediated rejection. There were no surgical complications except postoperative bleeding in 1 patient. Mean serum creatinine at 2 weeks after transplant was 71 ± 18 μmol/L (0.8 ± 0.2 mg/dL). At mean follow-up 267 days (range, 1-19 mo), there was no graft loss or patient death.
  
  
  CONCLUSIONS
  The ABO-incompatible kidney transplants were successful after the preconditioning protocol that included double-filtration plasmapheresis and rituximab. The use of ABO-incompatible kidney transplant may increase the availability of kidney transplant and avoid or shorten dialysis. Future multicenter studies are justified to develop a standardized preconditioning protocol.
authors.affiliation: From the Department of Internal Medicine and the Keimyung University Kidney Institution, Daegu, Korea.
authors.forename: Seungyeup
authors.initials: S
authors.lastname: Han
authors.forename: Eunah
authors.initials: E
authors.lastname: Hwang
authors.forename: Sungbae
authors.initials: S
authors.lastname: Park
authors.forename: Uijun
authors.initials: U
authors.lastname: Park
authors.forename: Hyoungtae
authors.initials: H
authors.lastname: Kim
authors.forename: Wonhyun
authors.initials: W
authors.lastname: Cho
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001787:Blood Group Incompatibility / Q000097:blood / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006648:Histocompatibility; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007518:Isoantibodies / Q000097:blood; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods*; D000069283:Rituximab; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System; D058846:Antibodies, Monoclonal, Murine-Derived; D015415:Biomarkers; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D000069283:Rituximab