Desensitization Protocol in Highly HLA-Sensitized and ABO-Incompatible High Titer Kidney Transplantation

Uchida, Junji; Machida, Yuichi; Iwai, Tomoaki; Naganuma, Takeshi; Kitamoto, K.; Iguchi, Taro; Maeda, Satoshi; Kamada, Yuko; Kuwabara, N.; Kim, T.; Nakatani, Tatsuya

doi:10.1016/j.transproceed.2010.09.043

Cited by 32 publications

(24 citation statements)

References 13 publications

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“…The rate of ABO-incompatibility may be high among kidney transplants from spousal donors, but it has been performed since the late 1980s in Japan due to the severe shortage of deceased donors. Previous reports have shown our superb outcomes of ABO-incompatible kidney transplants, including high-titer cases performed at our institution [8,9,10,12]. However, the outcomes of ABO-incompatible kidney transplantation in elderly patients older than 60 years have not yet been well studied.…”

Section: Discussionmentioning

confidence: 86%

“…The recipient with high anti-A/B titers received a desensitization protocol consisting of 2 doses of rituximab 150 mg/m 2 at 2 weeks before and on the day of transplantation, splenectomy, and pretransplant administration of 4 weeks of MMF 1 g/day and MP 8 mg/day (fig. 2) [9,10,11,12,13]. To remove the anti-A/B antibodies, the three recipients with low anti-A/B titers (<1:512) underwent standard antibody removal consisting of 3 sessions of double filtration plasmapheresis (DFPP) and 1 session of plasma exchange (PE).…”

Section: Methodsmentioning

confidence: 99%

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Clinical Outcome of Elderly Kidney Transplant Recipients from Spousal Donors

et al. 2015

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Introduction: Patients aged 60 years and older stand for the fastest growing group of patients with end-stage renal disease worldwide, and the need for kidney transplants among this population is rising. In Japan, living donor kidney transplantation is mainly performed to deal with the severe shortage of deceased donors, and the number of spousal transplants is currently increasing. Patients and Methods: A total of 164 patients with ESRD underwent living donor kidney transplantation at our institution, of whom 21 patients aged 60 years and older had spousal kidney transplantation. ABO-incompatible kidney transplantation was performed in 5 of the 21 cases. We analyzed these recipients. Results: Patient and graft survival rates were 100%. The incidence of acute rejection was 23.8%. Eight patients experienced cytomegalovirus viremia, two patients experienced Pneumocystis jiroveci infection, and one experienced bacterial pneumonia. Two patients developed cancers and underwent curative operation after transplantation. Conclusions: Elderly kidney transplantation from spousal donors is associated with age-related immune dysfunction, which may develop infections and malignancies and could be immunologically high risk due to the high rate of ABO-incompatibility and poor histocompatibility. An effort to minimize the adverse effect of immunosuppression and to reduce the risk of acute rejection may be needed for an excellent long-term outcome.

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Section: Discussionmentioning

confidence: 86%

Section: Methodsmentioning

confidence: 99%

Clinical Outcome of Elderly Kidney Transplant Recipients from Spousal Donors

et al. 2015

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“…In cases that seemed to be high risk, additional desensitization was performed to avoid antibody-mediated rejection by anti-A/B antibodies. The patients with anti-A/B antibody titers of more than 1: 1048 received 2 doses of rituximab (150 mg/m 2 ) and additionally underwent splenectomy (case 1 and 3) [15]. This study was approved by the Ethics Committee of Osaka City University Graduate School of Medicine (No.…”

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes of ABO-Incompatible Kidney Transplantation in Patients with End-Stage Kidney Disease due to Diabetes Nephropathy

et al. 2019

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Background: Diabetes nephropathy is one of the most common causes of end-stage kidney disease (ESKD) worldwide. The data are clear that kidney transplantation is superior to remaining on dialysis for patients with diabetes. However, there have been no reports on ABO-incompatible kidney transplantation in patients with ESKD due to diabetes nephropathy. Patients and Methods: We conducted a retrospective, observational study to investigate the clinical outcomes of ABO-incompatible kidney transplantation for patients with pre-existing diabetes nephropathy at our institution from April 2011 to October 2017. A total of 14 recipients were enrolled in this study. Results: All 14 patients underwent successful kidney transplantation. Both overall patient and graft survival rates were 100, 89.9, and 89.9% at 1, 3, and 5 years, respectively. One patient died 20 months after transplantation with a functioning graft due to pancreas cancer. Two of the 14 patients (14.3%) developed biopsy-proven acute cellular rejection during the follow-up period. The median observation period was 32.0 months (range 5–83 months). Conclusion: ABO-incompatible kidney transplantation may be an acceptable renal replacement therapy for ESKD patients with diabetes.

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“…The patients with high titers (≥1:512) or with donor-specific antibody received both a splenectomy on the day of transplantation and on administration of 2 doses of rituximab (high-titer protocol; fig. 3) [6,7]. To remove the anti-A/B antibodies, the patients underwent 1-12 sessions (over 1 session) of double filtration plasmapheresis (DFPP) or plasma exchange (PE) prior to kidney transplantation until the anti-A/B antibody titers were ≤1:16.…”

Section: Methodsmentioning

confidence: 99%

“…Rituximab induces long-lasting B-cell depletion in the peripheral blood. Using rituximab, we have performed successful ABO-incompatible kidney transplants in recipients without splenectomy [3,5] as well as in those with high pretransplant anti-A/B antibody titers [6,7]. Most reports on the experience with rituximab in kidney transplantation have been made on ABO-incompatible transplantation, where low rates of acute rejection have been observed [8].…”

Section: Introductionmentioning

confidence: 99%

ABO-Incompatible Living Kidney Transplant Recipients from Spousal Donors Receiving Rituximab

Uchida

Iwai²,

Kabei³

et al. 2016

Urol Int

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Introduction: We summarized our experience with ABO-incompatible living kidney transplant recipients from spousal donors receiving rituximab. Patients and Methods: Between June 2006 and December 2014, 82 patients with end-stage renal disease underwent living donor kidney transplantation at Osaka City University Hospital, of which 23 cases were ABO-incompatible transplantation between spouses with rituximab induction. We analyzed these recipients, focusing on their immunosuppressive protocols, frequency of acute rejections, and patient/graft survivals. Results: Patient and graft survival rates were 100%. The incidence of acute cellular rejection (ACR) was 30.4%. One patient experienced antibody-mediated rejection (AMR) and intractable ACR, 2 had AMR, and 2 had intractable ACR episodes that were treated using thymoglobulin. Conclusions: This study demonstrated that ABO-incompatible kidney transplantation between spouses using rituximab is a radical but effective treatment for end-stage renal disease. However, this procedure could be immunologically high risk due to ABO-incompatibility and poor histocompatibility.

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Desensitization Protocol in Highly HLA-Sensitized and ABO-Incompatible High Titer Kidney Transplantation

Cited by 32 publications

References 13 publications

Clinical Outcome of Elderly Kidney Transplant Recipients from Spousal Donors

Clinical Outcome of Elderly Kidney Transplant Recipients from Spousal Donors

Clinical Outcomes of ABO-Incompatible Kidney Transplantation in Patients with End-Stage Kidney Disease due to Diabetes Nephropathy

ABO-Incompatible Living Kidney Transplant Recipients from Spousal Donors Receiving Rituximab

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