title: Successful Transplantation in ABO- and HLA-Incompatible Living Kidney Transplant Patients: A Report on 12 Cases.
abstract: Few studies have assessed the outcomes of ABOi/HLAi living-kidney transplantation. We report a single-center experience of 12 ABOi/HLAi living-kidney recipients. Twenty-seven donor-specific alloantibodies (DSAs) (1-6 per patient) were found with fluorescence intensities of 1500-15 000. Desensitization was based on IVIg, two doses of rituximab (375 mg/m2), tacrolimus-based (0.2 mg/kg) immunosuppression (started on day-10 pretransplant), and 11 (6-27) pretransplant apheresis sessions (plasmapheresis, specific or semi-specific immunoadsorption). By day 0, 17 of the 27 DSAs had become undetectable. After 19 (3-51) months, patient- and graft-survival rates were 100% and 91.6%, respectively. One patient had an acute humoral rejection whereas three had a chronic antibody-mediated rejection (CAMR). At the last follow-up, kidney biopsies were nearly normal in seven cases (58.3%) and renal function was excellent except for the three cases of CAMR. Four patients had a BK virus infection. We conclude that ABOi/HLAi living-kidney transplantation is a reasonable option for highly sensitized patients.
authors.affiliation: CHU Rangueil, Nephrology, Dialysis, Transplantation, Toulouse, France. rostaing.l@chu-toulouse.fr.|CHU Purpan, INSERM01043, IFR-BMT, Toulouse, France. rostaing.l@chu-toulouse.fr.|Université Toulouse 3 Paul Sabaiter, Toulouse, France. rostaing.l@chu-toulouse.fr.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.affiliation: CHU Rangueil, DNTO, Toulouse, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Karam
authors.affiliation: Université Toulouse 3 Paul Sabaiter, Toulouse, France.|CHU Rangueil, Laboratory of Immunology, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Congy-Jolivet
authors.affiliation: CHU Rangueil, Nephrology, Dialysis, Transplantation, Toulouse, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Hage
authors.affiliation: CHU Rangueil, Department of Urology, Andrology and Transplantation, Toulouse, France.
authors.forename: Federico
authors.initials: F
authors.lastname: Sallusto
authors.affiliation: CHU Rangueil, Nephrology, Dialysis, Transplantation, Toulouse, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Esposito
authors.affiliation: CHU Rangueil, Department of Urology, Andrology and Transplantation, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Doumerc
authors.affiliation: CHU Purpan, Etablissement Français du Sang de Midi-Pyrénées, Toulouse, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Debiol
authors.affiliation: CHU Rangueil, Laboratory of Histopathology, Toulouse, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Guilbeau-Frugier
authors.affiliation: Université Toulouse 3 Paul Sabaiter, Toulouse, France.|CHU Rangueil, Department of Urology, Andrology and Transplantation, Toulouse, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Game
authors.affiliation: CHU Rangueil, Nephrology, Dialysis, Transplantation, Toulouse, France.
authors.forename: Asma
authors.initials: A
authors.lastname: Allal
authors.affiliation: CHU Rangueil, Nephrology, Dialysis, Transplantation, Toulouse, France.|Université Toulouse 3 Paul Sabaiter, Toulouse, France.|IFB-BMT - CHU Purpan, INSERM U563, Toulouse, France.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D000368:Aged; D001781:Blood Component Removal / Q000379:methods; D001787:Blood Group Incompatibility / Q000276:immunology*; D003888:Desensitization, Immunologic / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility; D006801:Humans; D007163:Immunosorbent Techniques; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods; D000069283:Rituximab / Q000008:administration & dosage; D016559:Tacrolimus / Q000008:administration & dosage; D013997:Time Factors
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D000069283:Rituximab; D016559:Tacrolimus
keywords: ABO incompatibility; Antibody-mediated rejection; Donor-specific alloantibodies; HLA incompatibility; Kidney transplantation