ABO Incompatible Kidney Transplantations Without Splenectomy, Using Antigen-Specific Immunoadsorption and Rituximab

Abstract

ABO incompatible kidney transplantations have previously only been performed after several preoperative sessions of plasmapheresis and splenectomy, with the conventional triple-drug immunosuppressive protocol being reinforced with antilymphocyte globulin and Bcell-specific drugs, such as cyclophosphamide or deoxyspergualine. We have designed a protocol without splenectomy, based on antigen-specific immunoadsorption, rituximab and a conventional triple-drug immunosuppressive protocol. The protocol calls for a 10-day pretransplantation conditioning period, starting with one dosage of rituximab and followed by full dose tacrolimus, mycophenolate mofetil and prednisolone. Antigen-specific immunoadsorption was performed on pretransplantation days −6, −5, −2 and −1. After the last session, 0.5 g/kg of intravenous immunoglobulin (IVIG) was administered. Postoperatively, three more apheresis sessions were given every third day. Furthermore, if there was a significant increase in the antibody titers, extra sessions were considered. Eleven patients have received transplants with this protocol. The ABO antibodies were readily removed by the antigen-specific immunoadsorption and were kept at a low level post-transplantation by further adsorptions. There were no side effects and all patients have normal renal transplant function. We conclude that after an infusion each of rituximab and IVIG, and antigen-specific immunoadsorption; blood groupincompatible renal transplantations can be performed with excellent results using standard immunosuppression and no splenectomy.

Principles of Separation

“…ESRD patients who have high panel-reactive antibodies or donor-specific antibodies undergo desensitization, a complex medical regimen in which donor-specific antibodies are eliminated and production of new antibodies is inhibited to decrease immunologic risk and allow safer transplantation (52)(53)(54)(55)(56)(57)(58). Acute humoral rejection of renal allografts is caused by alloantibodies that cause kidney injury in the peritubular capillaries, resulting in endothelial damage, loss of capillary patency, ischemia, and proliferation of myofibroblasts.…”

CD20 Expression in the Transplanted Kidney of Patients with Graft Loss and Transient Allograft Dysfunction

“…Moreover, isolated case reports have described the successful treatment of steroid-resistant episodes of acute rejection with specific anti-CD20 monoclonal antibody (Rituximab) (10). Rituximab has been clinically applied in the treatment of B cells related diseases including multiple myeloma (11).…”

AB0 nesuderinamumas neturi įtakos ankstyvam inkstų transplantato funkcionavimui po gyvų donorų organų transplantacijos

“…Vienas šios problemos sprendimo būdų -AB0n inkstų transplantacija. Tiek trumpalaikiai, tiek ilgalaikiai tokių pacientų stebėjimai parodė, kad AB0n protokolai, kombinuojant rituksimabą, donarui specifišką imunoadsorbciją bei trigubą imunosupresiją, tolygūs AB0 tapačių kraujo grupių transplantacijai, nepasireiškiant skirtumams tarp recipiento/alografto išgyvenamumo [2,3,4,5,6]. Šiame straipsnyje pateikiame duomenis apie 32 inkstų transplantacijas iš gyvų donorų, kurių 10 buvo netapačių kraujo grupių inksto transplantacijos.…”