Short-Term Outcomes of ABO-Incompatible Living Donor Kidney Transplantation With Uniform Protocol: Significance of Baseline Anti-ABO Titer

Lee, K.W.; Park, J.B.; Oh, Dong Kyu; Na, B.G.; Choi, Jin Yong; Cho, W.T.; Lee, S.H.; Park, H.J.; Cho, D.; Huh, Woo Seong; Kim, Seung Ju

doi:10.1016/j.transproceed.2016.01.027

Cited by 14 publications

(3 citation statements)

References 25 publications

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“…The use of low-dose Rituximab increased the risk of AMR in patients with high baseline isoagglutinin titer. It was concluded that patients with high baseline isoagglutinin titers should be given intensified preconditioning with Rituximab at a dose of 375 mg/m 2 along with IVIG [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

ABO-Incompatible Renal Transplantation with High Antibody Titer: A Case Report

Ray

Thukral

2017

Am J Case Rep

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Patient: Male, 33Final Diagnosis: ABO-incompatible kidney transplantation with high antibody titerSymptoms: Symptoms of end stage real diseaseMedication: —Clinical Procedure:—Specialty: TransplantologyObjective:Management of emergency careBackground:Even though renal transplantation across blood groups is not uncommonly practiced nowadays, there is still hesitation regarding ABO-incompatible transplantation with very high baseline antibody titer. In this case report, the outcome of an ABO-incompatible kidney transplant recipient with a high baseline isoagglutinin titer is reported.Case Report:The patient was a non-diabetic, 33-year-old man with end-stage renal disease secondary to chronic glomerulonephritis. The only kidney donor available was his mother, who was blood-group incompatible. The patient’s blood group was O positive, whereas his mother was B positive. We evaluated him for an ABO-incompatible renal transplant. The baseline anti-B isoagglutinin titer was >1: 8196. With a desensitization protocol of low-dose Rituximab, plasmapheresis, and IVIG, this titer was brought down to 1: 32 before transplantation. He successfully underwent renal transplantation across the ABO barrier, and maintains good graft function after 1 year of follow-up.Conclusions:In the present era, a high baseline isoagglutinin titer is no longer a contraindication for successful kidney transplantation in ABO-incompatible recipient-donor pairs.

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Section: Discussionmentioning

confidence: 99%

ABO-Incompatible Renal Transplantation with High Antibody Titer: A Case Report

Ray

Thukral

2017

Am J Case Rep

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“…Ezeknél a betegeknél az alacsony dózisban (200 mg egyszeri adag) alkalmazott rituximab (rMAB) nem volt hatásos. A szerzők a magas antitesttiter mellett az intenzív deszenzitizációt javasolják, amely magas dózisú rMAB (375 mg/m 2 ), IVIG és ismételt PF alkalmazását jelenti [58].…”

Section: Ab0-és Hla-inkompatibilis Veseátültetések Mint öNálló Rizikófaktorunclassified

Antitestmediált rejekció: kihívás a veseátültetett betegek kezelésében

et al. 2018

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Antibody-mediated rejection (ABMR) is one of the factors affecting the long-term graft survival after kidney transplantation (KT). Two kidney transplant centres (University of Debrecen and University of Pécs) followed up their data of cadaveric KTs that had been performed between 2013 and 2017, and reviewed the literature. There were 454 KTs in the mentioned period, 18 cases (4%) were recognised as ABMRs. Biopsy has been performed in all cases. 22% were primary, and 78% retransplanted patients. The average age was 51.2 ± 6 years. ABMR occurred 15.4 ± 22.1 months after KT. Histology showed C4d positivity in 39% of the cases. The treatment was steroid bolus + intravenous immunoglobulin (IVIG) + plasma exchange (PE) in 16 cases, rituximab was additionally given in 5 cases. 47.4% of the patients are alive with a functioning graft, four (21%) died, and 31% of the patients had a graft loss due to ABMR. ABMR is a dangerous complication after KT. Diagnostic criteria has been unclear for years. Gold standard is the histology, however, accelerated ABMR may occur even in C4d negative cases. The exposed group includes young, retransplanted patients, having a preformed donor-specific antibody (DSA), and receiving a graft from an EC donor. The occurrence of de novo DSA and the kinetics of mean fluorescence intensity (MFI) of existing ones can be a signal for the risk of an ABMR. The effectiveness of rituximab is not proven, there is a lack of long-term controlled trials for new drugs. Our results of over 40% recovery is an extensively good result. Orv Hetil. 2018; 159(46): 1913–1929.

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“…Since the first ABO-incompatible (ABOi) kidney transplantation (KT), was carried out in Japan in 1989 and excellent long-term outcomes were obtained in subsequence surgeries (1)(2)(3), the number of cases of ABOi-KT have gradually increased worldwide. To avoid graft rejection in ABOi-KT, immunosuppression is usually used to maintain the titre of ABO blood group antibodies at a low level and to inhibit B-cell activation (4)(5)(6). However, antibody-mediated graft rejection is still one of the major causes of poor outcome in the clinic.…”

Section: Introductionmentioning

confidence: 99%

Identification of an activation‑related protein in B cells in the ABO incompatible condition

et al. 2019

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In ABO-incompatible (ABOi) kidney transplantation (KT), antibodies can mediate immunological accommodation or immune rejection, but the mechanism by which B cells are induced to produce antibodies with different functions is still unclear. Previous research established an ABOi kidney cell model and identified that haptoglobin (HP) is associated with the activation of lymphocytes. In the present study, the results of a flow cytometric assay demonstrated that HP was expressed by B cells. Moreover, dot-ELISA and ELISA analyses showed that the concentrations of total IgG, blood group B antibody, IgG1, IgG2 and IgG4 were all significantly increased in the cell model. In addition, dot-ELISA and haptoglobin level analyses showed that HP protein expression was significantly increased, while RT-qPCR assay indicated that HP was significantly reduced at the mRNA level. Furthermore, bioinformatics analysis showed that HP could interact with Smad3, and the HP-Smad3 complex was detected in a peripheral blood mononuclear cell (PBMC) protein extract by a dot-ELISA method. This research revealed that HP was involved in the process of B-cell activation by interacting with Smad3, and the results will be helpful to reveal the mechanism of B-cell activation in ABOi-KT.

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Short-Term Outcomes of ABO-Incompatible Living Donor Kidney Transplantation With Uniform Protocol: Significance of Baseline Anti-ABO Titer

Cited by 14 publications

References 25 publications

ABO-Incompatible Renal Transplantation with High Antibody Titer: A Case Report

ABO-Incompatible Renal Transplantation with High Antibody Titer: A Case Report

Antitestmediált rejekció: kihívás a veseátültetett betegek kezelésében

Identification of an activation‑related protein in B cells in the ABO incompatible condition

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