Desensitization with plasmapheresis and anti-Cd20 for ABO incompatible kidney transplantation from living donor: experience of a single center in Italy.

Abstract

OBJECTIVE:

Blood group incompatibility in kidney transplants from a living donor can be successfully overcome by using various desensitization protocols: intravenous immunoglobulin, plasmapheresis (PP), immunoadsorption, and double filtration PP.

PATIENTS AND METHODS:

From July 2010 to October 2013, we performed 10 ABO incompatible kidney transplantation (KT) procedures from a living donor. The desensitization protocol was based on rituximab and PP+cytomegalovirus immune globulin. All patients received induction with basiliximab, except 1 case treated with Thymoglobuline® (ATG) for the simultaneous presence of donor-specific antibody. Tacrolimus and mycophenolate mofetil were initiated at the time of desensitization and continued after the transplant.

RESULTS:

After a mean follow-up of 11.6±10.4 months, all patients are alive with a functioning graft. The mean serum creatinine concentration at 1 month, 3 months, 6 months, and 1 year was 1.48±0.29, 1.47±0.18, 1.47±0.27, and 1.5±0.27 mg/dl. Three episodes of acute cellular rejection occurred in 2 patients. There was only 1 case of BK virus infection, treated with reduction of immunosuppressive therapy. The protocol biopsy specimens at 1, 3, and 6 months were C4d positive in the absence of acute rejection.

CONCLUSIONS:

Desensitization with rituximab, PP, and anti-cytomegalovirus immune globulin allowed us to perform transplants from living donors to ABO incompatible recipients with excellent results and reduced costs.

• Authors: C Silvestre, L Furian, P Marson, T Tison, M Valente, F Marchini, B Rossi, L Bonfante, F Valerio, E Cozzi, P Rigotti
• Journal: Transplantation proceedings (Transplant Proc) Vol. 46 Issue 7 Pg. 2209-13 (Sep 2014) ISSN: 1873-2623 [Electronic] United States
• PMID: 25242753 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• ABO Blood-Group System
• Antibodies, Monoclonal, Murine-Derived
• Immunoglobulins
• Immunologic Factors
• Rituximab

Topics

• ABO Blood-Group System
• Adult
• Antibodies, Monoclonal, Murine-Derived (therapeutic use)
• Blood Group Incompatibility (immunology)
• Cytomegalovirus Infections (prevention & control)
• Desensitization, Immunologic (methods)
• Female
• Humans
• Immunoglobulins (therapeutic use)
• Immunologic Factors (therapeutic use)
• Italy
• Kidney Transplantation
• Living Donors
• Male
• Middle Aged
• Plasmapheresis
• Rituximab
• Young Adult