Initial experience with ABO-incompatible live donor renal transplantation
Journal
Journal of the Formosan Medical Association
Journal Volume
105
Journal Issue
9
Pages
775-779
Date Issued
2006
Author(s)
Abstract
The serious shortage of cadaveric organs has prompted the development of ABO-incompatible live donor renal transplantation. We report our experience of the initial two live donor ABO incompatible renal transplants at our hospital. The first patient was a 55-year-old type A female who received a kidney from her AB type husband. The second patient was a 27-year-old type O male who received renal transplantation from his type A father. Preconditioning immunosuppressive therapy in the two patients with tacrolimus, mycophenolate mofetil and methylprednisolone was started 7 days before transplantation. During the period of preconditioning, double filtration plasmapheresis (DFPP) was employed to remove anti-A and -B antibodies. Laparoscopic splenectomy and renal transplantation were performed after the anti-donor ABO antibodies were reduced to a titer of 1:4. Rituximab, a humanized monoclonal anti- CD20 antibody, was administered to the second patient due to a rebound in the anti-A antibody titer during the preconditioning period. Under a tacrolimus-based immunosuppressive regimen, both patients recovered very well without any evidence of rejection. Serum creatinine levels were 1.0 and 1.4 mg/dL at 6 and 3 months after transplantation, respectively. These cases illustrate that with new immunosuppressive agents, DFPP and splenectomy, ABO-incompatible renal transplantation can be successfully conducted in end-stage renal disease patients whose only available live donors are blood group incompatible. ? 2006 Elsevier & Formosan Medical Association.
SDGs
Other Subjects
creatinine; fresh frozen plasma; glucose; hemoglobin; methylprednisolone; mycophenolic acid 2 morpholinoethyl ester; nitrogen; prednisolone; rapamycin; rapaume; rituximab; tacrolimus; unclassified drug; urea; adult; antibody titer; article; blood cell count; blood clotting disorder; blood group AB; blood group ABO incompatibility; case report; chronic kidney failure; clinical feature; continuous infusion; creatinine blood level; dose response; drug dose reduction; drug substitution; epigastric pain; female; glucose blood level; hemoglobin determination; HLA system; human; immunological monitoring; immunosuppressive treatment; kidney transplantation; laboratory test; laparoscopic surgery; leukocyte count; liver function test; living donor; lymphocyte depletion; male; nephrectomy; physical examination; plasmapheresis; postoperative period; recipient; splenectomy; thrombocyte count; treatment outcome; urea nitrogen blood level; vomiting
Publisher
Scientific Communications International Ltd
Type
journal article