ABO Incompatible Renal Transplantation without Augmented Immunosuppression or Antibody Removal - Report of 10 Cases

Brown, Audrey E.; Carter, V.; Howell, Michael D.; Russell, Kim; Torpey, Nick

doi:10.1097/00007890-201211271-00120

Cited by 4 publications

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“…In a previously published series of 31 patients with higher ABGAb titers underwent perioperative antibody removal, the three patients experiencing AbMR had titers between 1:128 and 1:4096 . These findings, in conjunction with those from the current series suggest that baseline ABGAb titer is the strongest predictor of early AbMR in ABOi, with confirmatory evidence from a recent study of 10 patients undergoing ABOi without antibody removal .…”

Section: Discussionsupporting

confidence: 86%

ABO Incompatible Renal Transplantation Without Antibody Removal Using Conventional Immunosuppression Alone

Masterson

Hughes

Walker

et al. 2014

American Journal of Transplantation

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ABO incompatible living donor renal transplantation (ABOi) can achieve outcomes comparable to ABO compatible transplantation (ABOc). However, with the exception of blood group A2 kidneys transplanted into recipients with low titer anti‐A antibody, regimens generally include antibody removal, intensified immunosuppression and splenectomy or rituximab. We now report a series of 20 successful renal transplants across a range of blood group incompatibilities using conventional immunosuppression alone in recipients with low baseline anti‐blood group antibody (ABGAb) titers. Incompatibilities were A1 to O (3), A1 to B (2), A2 to O (2), AB to A (2), AB to B (1), B to A1 (9), B to O (1); titers 1:1 to 1:16 by Ortho. At 36 months, patient and graft survival are 100%. Antibody‐mediated rejection (AbMR) occurred in one patient with thrombophilia and low level donor‐specific anti‐HLA antibody. Four patients experienced cellular rejection (two subclinical), which responded to oral prednisolone. This series demonstrates that selected patients with low titer ABGAb can undergo ABOi with standard immunosuppression alone, suggesting baseline titer as a reliable predictor of AbMR. This reduces morbidity and cost of ABOi for patients with low titer ABGAb and increases the possibility of ABOi from deceased donors.

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Section: Discussionsupporting

confidence: 86%

ABO Incompatible Renal Transplantation Without Antibody Removal Using Conventional Immunosuppression Alone

Masterson

Hughes

Walker

et al. 2014

American Journal of Transplantation

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“…Initially, the number of participating centres participating was low , however, the new Kidney Allocation Scheme in the USA has led to a significant increase in A2 donors being used for ABO‐incompatible transplants . Additionally, there is mounting evidence that for patients with low‐titres of anti‐A or anti‐B antibody (<1:16), there is no requirement for any augmentation to conventional immunosuppression, or need for desensitization therapy with plasmapheresis .…”

Section: Discussionmentioning

confidence: 99%

For the many: permitting deceased donor kidney transplantation across low‐titre blood group antibodies can reduce wait times for blood group B recipients, and improve the overall number of 000MMtransplants ‐ a multicentre observational cohort study

et al. 2019

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Summary Blood group O or B recipients wait longer for a kidney transplant. We studied the distribution of anti‐ABO blood group antibody titres in patients awaiting a kidney transplant, and modelled the effect of altering the UK National Kidney Allocation Scheme to allow for patients with ‘LOW’ titres (≤1:8, ≤3 dilutions) to receive a deceased donor ABOi (ddABOi) transplant. In a prospective study of 239 adult patients on the waiting list for a transplant in 2 UK centres, ABO‐antibody titres (anti‐A and anti‐B) were measured. Based on the proportions of ‘LOW’ anti‐A or anti‐B antibodies, four simulations were performed to model the current allocation rules compared with variations allowing ddABOi allocation under various conditions of blood group, HLA matching, and waiting time. The simulations permitting ddABOi resulted in more blood group B recipients being transplanted, with median waiting time reduced for this group of recipients, and more equitable waiting times across blood groups. Additionally, permitting ddABOi resulted in greater numbers of 000MM allocations overall in compatible transplants under modelled conditions. Changing allocation in the UK to permit ddABOi in patients with ‘LOW’ titres would not change the total number of transplants, but redistributes allocation more equitably amongst blood groups, altering waiting times accordingly.

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Histological and Extended Clinical Outcomes After ABO-Incompatible Renal Transplantation Without Splenectomy or Rituximab

et al. 2017

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ABO-incompatible renal transplant performed with antibody removal and conventional immunosuppression continues to provide excellent patient and graft survival, and stable renal function over 4 years. Coupled with absent transplant glomerulopathy and low rates of progressive IF/TA on earlier biopsies, this suggests that ABOi with conventional immunosuppression and antibody removal, without rituximab or splenectomy, can achieve long-term outcomes comparable to ABO-compatible transplantation.

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ABO Incompatible Renal Transplantation without Augmented Immunosuppression or Antibody Removal - Report of 10 Cases

Cited by 4 publications

References 0 publications

ABO Incompatible Renal Transplantation Without Antibody Removal Using Conventional Immunosuppression Alone

ABO Incompatible Renal Transplantation Without Antibody Removal Using Conventional Immunosuppression Alone

For the many: permitting deceased donor kidney transplantation across low‐titre blood group antibodies can reduce wait times for blood group B recipients, and improve the overall number of 000MMtransplants ‐ a multicentre observational cohort study

Histological and Extended Clinical Outcomes After ABO-Incompatible Renal Transplantation Without Splenectomy or Rituximab

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