Rapid accomodation of an a1 renal allograft after preconditioning for ABO-incompatible transplantation

Geoff Allen, Christopher E. Simpkins, Dorry Segev, Daniel Warren, Karen King, Janis Taube, Jayme Locke, William Baldwin, Mark Haas, Raghu Chivukula, Robert A. Montgomery

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Background: Successful ABO-incompatible (ABOi) kidney transplantation of non-A2 renal allografts requires preconditioning to reduce anti-blood group antibody to safe lev-els in order to avoid hyperacute rejection. Unfortunately, early post-transplant acute antibody-mediated rejection remains a problem in these patients and can result in rapid graft loss. A number of investigators have encountered ABOi recipients who have had no evidence of allograft injury in the setting of elevated titers of anti-ABO antibody, a protective phe-nomenon that has been termed 'accommodation'. Little is known about the time course of accommodation. We report a case of a successful ABOi renal transplant recipient who had evidence of accommodation within the first week following transplantation. Case Report: The patient is a 36-year-old, highly sensitized blood group·woman who underwent live donor transplantation from her human leukocyte antigen-identical blood group A1 brother following therapy with plasmapheresis and low-dose intravenous immunoglobulin for an ini-tial anti-A anti-human globulin antibody titer of 512. Within the first week following trans-plantation, her anti-A titer rose to 128 without change in her renal function. At 1 month following transplantation, her anti-A titer had risen to 256 at which time a biopsy was per-formed that demonstrated no evidence of antibody-mediated rejection. Conclusion: This patient demonstrates that accommodation of the renal allograft following ABOi transplanta-tion may take place in the early postoperative period in the setting of high titer antibody. The implications for postoperative management of the ABOi patient and the need for future investigation in this area are discussed.

Original languageEnglish (US)
Title of host publicationHumoral Immunity in Kidney Transplantation
Subtitle of host publicationWhat Clinicians Need to Know
EditorsGiuseppe Remuzzi, Norberto Perico, Stefano Chiaramonte, Claudio Ronco
Pages35-46
Number of pages12
DOIs
StatePublished - Jul 31 2009

Publication series

NameContributions to Nephrology
Volume162
ISSN (Print)0302-5144

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ASJC Scopus subject areas

  • Nephrology

Cite this

Allen, G., Simpkins, C. E., Segev, D., Warren, D., King, K., Taube, J., Locke, J., Baldwin, W., Haas, M., Chivukula, R., & Montgomery, R. A. (2009). Rapid accomodation of an a1 renal allograft after preconditioning for ABO-incompatible transplantation. In G. Remuzzi, N. Perico, S. Chiaramonte, & C. Ronco (Eds.), Humoral Immunity in Kidney Transplantation: What Clinicians Need to Know (pp. 35-46). (Contributions to Nephrology; Vol. 162). https://doi.org/10.1159/000170811