TY - JOUR
T1 - Plasmapheresis, CMV hyperimmune globulin, and anti-CD20 allow ABO-incompatible renal transplantation without splenectomy
AU - Sonnenday, Christopher J.
AU - Warren, Daniel S.
AU - Cooper, Mathew
AU - Samaniego, Milagros
AU - Haas, Mark
AU - King, Karen E.
AU - Shirey, R. Sue
AU - Simpkins, Christopher E.
AU - Montgomery, Robert A.
PY - 2004/8
Y1 - 2004/8
N2 - The majority of preconditioning protocols developed to allow ABO-incompatible (ABOi) renal transplantation include concurrent splenectomy as a prerequisite to successful engraftment. Our center has developed a preconditioning protocol that includes plasmapheresis (PP), low-dose CMV hyperimmune globulin (CMVIg), and anti-CD20 monoclonal antibody (rituximab) to allow ABOi renal transplantation without splenectomy. Our initial experience has included treatment of six recipients and successful transplantation from blood group A1, A2, and group B living donors. Mean (± SD) serum creatinine was 1.3 ± 0.1 mg/dL among the six recipients and no episodes of antibody-mediated rejection (AMR) occurred at a median follow-up of 12 months. ABO antibody titers have remained below pretreatment levels. The absence of AMR and stable allograft function in this series show the potential of this preconditioning protocol to increase ABOi renal transplantation. The use of rituximab, allowing avoidance of splenectomy, may further remove one of the significant disincentives to ABOi transplantation, and eliminate the risk of post-splenectomy infections.
AB - The majority of preconditioning protocols developed to allow ABO-incompatible (ABOi) renal transplantation include concurrent splenectomy as a prerequisite to successful engraftment. Our center has developed a preconditioning protocol that includes plasmapheresis (PP), low-dose CMV hyperimmune globulin (CMVIg), and anti-CD20 monoclonal antibody (rituximab) to allow ABOi renal transplantation without splenectomy. Our initial experience has included treatment of six recipients and successful transplantation from blood group A1, A2, and group B living donors. Mean (± SD) serum creatinine was 1.3 ± 0.1 mg/dL among the six recipients and no episodes of antibody-mediated rejection (AMR) occurred at a median follow-up of 12 months. ABO antibody titers have remained below pretreatment levels. The absence of AMR and stable allograft function in this series show the potential of this preconditioning protocol to increase ABOi renal transplantation. The use of rituximab, allowing avoidance of splenectomy, may further remove one of the significant disincentives to ABOi transplantation, and eliminate the risk of post-splenectomy infections.
KW - ABO-incompatible
KW - Desensitization
KW - Renal transplantation
KW - Rituximab
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UR - http://www.scopus.com/inward/citedby.url?scp=3042746307&partnerID=8YFLogxK
U2 - 10.1111/j.1600-6143.2004.00507.x
DO - 10.1111/j.1600-6143.2004.00507.x
M3 - Article
C2 - 15268734
AN - SCOPUS:3042746307
SN - 1600-6135
VL - 4
SP - 1315
EP - 1322
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 8
ER -