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

Geoff Allen, Christopher E. Simpkins, Dorry Segev, Daniel Warren, Karen Eileen King, Janis M 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 publicationContributions to Nephrology
Pages35-46
Number of pages12
Volume162
DOIs
StatePublished - 2009

Publication series

NameContributions to Nephrology
Volume162
ISSN (Print)03025144

Fingerprint

Allografts
Transplantation
Kidney
Antibodies
Blood Group Antigens
Transplants
Plasmapheresis
Intravenous Immunoglobulins
Globulins
HLA Antigens
varespladib methyl
Postoperative Period
Kidney Transplantation
Siblings
Anti-Idiotypic Antibodies
Research Personnel
Tissue Donors
Biopsy
Wounds and Injuries
Rejection (Psychology)

ASJC Scopus subject areas

  • Nephrology

Cite this

Allen, G., Simpkins, C. E., Segev, D., Warren, D., King, K. E., Taube, J. M., ... Montgomery, R. A. (2009). Rapid accomodation of an a1 renal allograft after preconditioning for ABO-incompatible transplantation. In Contributions to Nephrology (Vol. 162, pp. 35-46). (Contributions to Nephrology; Vol. 162). https://doi.org/10.1159/000170811

Rapid accomodation of an a1 renal allograft after preconditioning for ABO-incompatible transplantation. / Allen, Geoff; Simpkins, Christopher E.; Segev, Dorry; Warren, Daniel; King, Karen Eileen; Taube, Janis M; Locke, Jayme; Baldwin, William; Haas, Mark; Chivukula, Raghu; Montgomery, Robert A.

Contributions to Nephrology. Vol. 162 2009. p. 35-46 (Contributions to Nephrology; Vol. 162).

Research output: Chapter in Book/Report/Conference proceedingChapter

Allen, G, Simpkins, CE, Segev, D, Warren, D, King, KE, Taube, JM, Locke, J, Baldwin, W, Haas, M, Chivukula, R & Montgomery, RA 2009, Rapid accomodation of an a1 renal allograft after preconditioning for ABO-incompatible transplantation. in Contributions to Nephrology. vol. 162, Contributions to Nephrology, vol. 162, pp. 35-46. https://doi.org/10.1159/000170811
Allen G, Simpkins CE, Segev D, Warren D, King KE, Taube JM et al. Rapid accomodation of an a1 renal allograft after preconditioning for ABO-incompatible transplantation. In Contributions to Nephrology. Vol. 162. 2009. p. 35-46. (Contributions to Nephrology). https://doi.org/10.1159/000170811
Allen, Geoff ; Simpkins, Christopher E. ; Segev, Dorry ; Warren, Daniel ; King, Karen Eileen ; Taube, Janis M ; Locke, Jayme ; Baldwin, William ; Haas, Mark ; Chivukula, Raghu ; Montgomery, Robert A. / Rapid accomodation of an a1 renal allograft after preconditioning for ABO-incompatible transplantation. Contributions to Nephrology. Vol. 162 2009. pp. 35-46 (Contributions to Nephrology).
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AB - 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.

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