title: Immune Desensitization Allows Pediatric Blood Group Incompatible Kidney Transplantation.
abstract: Blood group incompatible transplantation (ABOi) in children is rare as pretransplant conditioning remains challenging and concerns persist about the potential increased risk of rejection.
  
  
  
  We describe the results of 11 ABOi pediatric renal transplant recipients in the 2 largest centers in the United Kingdom, sharing the same tailored desensitization protocol. Patients with pretransplant titers of 1 or more in 8 received rituximab 1 month before transplant; tacrolimus and mycophenolate mofetil were started 1 week before surgery. Antibody removal was performed to reduce titers to 1 or less in 8 on the day of the operation. No routine postoperative antibody removal was performed.
  
  
  
  Death-censored graft survival at last follow-up was 100% in the ABOi and 98% in 50 compatible pediatric transplants. One patient developed grade 2A rejection successfully treated with antithymocyte globulin. Another patient had a titer rise of 2 dilutions treated with 1 immunoadsorption session. There was no histological evidence of rejection in the other 9 patients. One patient developed cytomegalovirus and BK and 2 others EBV and BK viremia.
  
  
  
  Tailored desensitization in pediatric blood group incompatible kidney transplantation results in excellent outcomes with graft survival and rejection rates comparable with compatible transplants.
authors.affiliation: 1 Department of Pediatric Nephrology and Transplantation at Evelina London Children's Hospital, London, United Kingdom. 2 Department of Transplantation at Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom. 3 Department of Pediatric Nephrology and Transplantation at Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom. 4 Department of Histopathology at Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: Jelena
authors.initials: J
authors.lastname: Stojanovic
authors.forename: Anna
authors.initials: A
authors.lastname: Adamusiak
authors.forename: Nicos
authors.initials: N
authors.lastname: Kessaris
authors.forename: Pankaj
authors.initials: P
authors.lastname: Chandak
authors.forename: Zubir
authors.initials: Z
authors.lastname: Ahmed
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Sebire
authors.forename: Grainne
authors.initials: G
authors.lastname: Walsh
authors.forename: Helen E
authors.initials: HE
authors.lastname: Jones
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Marks
authors.forename: Nizam
authors.initials: N
authors.lastname: Mamode
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000367:Age Factors; D001787:Blood Group Incompatibility / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006648:Histocompatibility; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008131:London; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage; D012307:Risk Factors; D000069283:Rituximab / Q000008:administration & dosage; D016559:Tacrolimus / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D000069283:Rituximab; D009173:Mycophenolic Acid; D016559:Tacrolimus