Immune Desensitization Allows Pediatric Blood Group Incompatible Kidney Transplantation

Stojanović, Jelena; Adamusiak, Anna; Kessaris, Nicos; Chandak, Pankaj; Ahmed, Zubir; Sebire, Neil J.; Walsh, Grainne; Jones, Helen; Marks, Stephen D.; Mamode, Nizam

doi:10.1097/tp.0000000000001325

Cited by 22 publications

(12 citation statements)

References 17 publications

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“…With expertise and better clinical expertise, we have now moved on to DFPP or IA with or without the use of IVIg. This is also in light of recent report from the United Kingdom on children undergoing blood group incompatible renal transplant …”

Section: Discussionsupporting

confidence: 58%

“…. Recent evidence has shown no significant differences in transplant outcomes after abandoning routine post‐op antibody removal: a notable distinction from Tyden's study protocol . We also do not routinely use post‐op apheresis and reserve it only for cases with a significant titer rebound with acute graft dysfunction cases only.…”

Section: Discussionmentioning

confidence: 85%

“…Recipients with a titer of 1:8 or less do not receive R and pretransplant apheresis. Although not widely practiced yet, it has yielded excellent outcomes, with graft survival and rejection rates comparable to compatible transplants in both adults and children . As all the children in our cohort had a titer greater than 1:8, pretransplant apheresis could not be forgone.…”

Section: Discussionmentioning

confidence: 86%

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Pediatric ABO‐incompatible kidney transplantation: Evolving with the advancing apheresis technology: A single‐center experience

Sethi

Bansal

Wadhwani

et al. 2018

Pediatric Transplantation

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Recent literature has endorsed favorable outcomes following ABOi kidney transplantation in pediatric population. Nevertheless, reluctance to pursue an ABOi still remains pervasive. This could be ascribed to various legitimate reasons, namely less extensive pediatric ABOi data, technical difficulties encountered during PP, cost restraints, and concerns regarding higher rates of antibody-mediated rejection, infectious complications, and post-transplant lymphoproliferative disorder as compared to adults. However, given the similar excellent outcomes of both ABOi and ABOc kidney transplantation, clinicians should consider this option sooner if a compatible donor or swap is not available. Here, we describe the outcomes of three pediatric ABOi performed at our institute in India (from 2014 till now), wherein distinct apheresis modalities had been employed in each desensitization protocol, and our techniques evolved with advancing science in apheresis. This case series includes India's first published pediatric ABO-incompatible transplant (Case 2) and the youngest child to undergo ABO-incompatible renal transplant in SAARC nations (Case 3).

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 86%

See 1 more Smart Citation

Pediatric ABO‐incompatible kidney transplantation: Evolving with the advancing apheresis technology: A single‐center experience

Sethi

Bansal

Wadhwani

et al. 2018

Pediatric Transplantation

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“…The treatment goal is to achieve a titration that is equal to or lower than 1/8 of the transplant, and to accomplish this, different desensitization strategies have been applied without reaching a consensus on which is the best. For example, in 2017 Stojanovic and his team published 14 In our case, the desensitization strategy was intense as our patient presented a history of DSA with elevated MFI, and therefore a high risk of antibody-mediated rejection as well as due to the incompatible blood group. This can occur even when the pretransplant crossmatch is negative as the DSA titer is too low to show it, triggering post-transplant alloresponse of memory cells and an increase in DSA titer, and therefore, with it, antibodymediated rejection.…”

Section: (A) (B) (C) (D)mentioning

confidence: 87%

Overcoming limits: First ABO incompatible living donor paired kidney transplant in an hypersensitized pediatric recipient in Spain

Baños

Revuelta

Codina

et al. 2022

Pediatric Transplantation

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Introduction HLA sensitization is a growing problem in children awaiting kidney transplantation. In some cases, finding an immunologically compatible donor entails contemplating the option of an ABO incompatible transplant or paired transplant. Methods Patient with genetic nephrotic syndrome and progressive chronic kidney disease, with a previous thrombosis of a first kidney transplant, resulting hypersensitized and remaining for a long‐time on hemodialysis. Despite a desensitization strategy, family members were incompatible and deceased donation options must be ruled out due to the presentation of donor‐specific antibodies (DSA). After 4 years, the possibility arises to perform a kidney paired transplant with a 62‐year‐old woman with an incompatible blood group. Although the current cytotoxicity‐ and cell‐based crossmatches were negative, history of DSA were recorded. Results An intensive ABO and HLA desensitization protocol was performed in order to combat the isohemagglutinin antibodies and on the memory‐HLA, based on rituximab, apheresis sessions, and immunoglobulins. Despite the donor being older in terms of pediatric transplantation, the donor‐recipient weight difference, and immunological risk, the transplant was completed successfully. Maintenance of titration of up to 1/2 was confirmed after 3 weeks post‐transplant (IgM and IgG). Kidney biopsy at 2 weeks and 6 months without signs of rejection. The patient is currently 12 months post‐transplant and has not presented any signs of transplant rejection and has proper renal function. Conclusions Kidney paired transplantation is an excellent solution for hypersensitized children, and ABO incompatibility can be considered to increase their options to find a good donor, without thereby obtaining worse results.

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“…Experience with ABO-incompatible pediatric renal transplantation provided the basis for optimizing antibody removal procedures in pediatric transplant recipients requiring antibody removal in the perioperative period or for treating antibody-mediated rejection [17–19]. There are recognized side effects of plasma exchange, such as clotting disturbances, hypoalbuminemia, and fluid shifts into the interstitial space, but these usually do not extend beyond a few days after antibody removal session and can be appropriately managed.…”

Section: Discussionmentioning

confidence: 99%

Desensitization protocol enabling pediatric crossmatch-positive renal transplantation: successful HLA-antibody-incompatible renal transplantation of two highly sensitized children

et al. 2016

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BackgroundRenal transplantation improves quality of life (QoL) and survival in children requiring renal replacement therapy (RRT). Sensitization with development of a broad-spectrum of anti-HLA antibodies as a result of previous transplantation or after receiving blood products is an increasing problem. There are no published reports of desensitization protocols in children allowing renal transplantation from HLA-antibody-incompatible living donors.MethodsWe adopted our well-established adult desensitization protocol for this purpose and undertook HLA antibody-incompatible living donor renal transplants in two children: a 14-year-old girl and a 13-year-old boy.ResultsAfter 2 and 1.5 years of follow-up, respectively, both patients have stable renal allograft function despite a rise in donor-specific antibodies in one case.ConclusionsHLA-incompatible transplantation should be considered in selected cases for sensitized children.

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Immune Desensitization Allows Pediatric Blood Group Incompatible Kidney Transplantation

Abstract: Tailored desensitization in pediatric blood group incompatible kidney transplantation results in excellent outcomes with graft survival and rejection rates comparable with compatible transplants.

Cited by 22 publications

References 17 publications

Pediatric ABO‐incompatible kidney transplantation: Evolving with the advancing apheresis technology: A single‐center experience

Pediatric ABO‐incompatible kidney transplantation: Evolving with the advancing apheresis technology: A single‐center experience

Overcoming limits: First ABO incompatible living donor paired kidney transplant in an hypersensitized pediatric recipient in Spain

Desensitization protocol enabling pediatric crossmatch-positive renal transplantation: successful HLA-antibody-incompatible renal transplantation of two highly sensitized children

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