Abo-Incompatible Living-Donor Kidney Transplantation in Children

Abstract

We have demonstrated that with adequate pre- and posttransplant management, successful kidney transplantation across the ABO barrier is possible in the pediatric population. "Accommodation" of the allografts occurred within 2 weeks of transplantation. Subsequently, the long-term graft outcome of ABO-incompatible LKT was comparable to that of ABO-compatible LKT.

Therapeutic plasma exchange for the treatment of pediatric renal diseases in 2013

“…The same center previously reported 16 pediatric ABO-incompatible living kidney transplants treated with plasma exchange or immunoabsorption prior to transplantation and splenectomy at the time of transplantation. The majority (56 %) had an increase in anti-ABO titers with an associated increase in serum creatinine (presumed AMR), and one child suffered graft loss due to delayed hyperacute rejection, although the 10-year graft survival was similar to that of ABO-compatible transplantation [21]. These data are consistent with data from adult series [20,22].…”

Allosensitization Does Not Increase the Risk of Xenoreactivity to ??1,3-Galactosyltransferase Gene-Knockout Miniature Swine in Patients on Transplantation Waiting Lists

“…While the potential role of anti- donor IgM antibodies in xenotransplantation remains to be determined, the presence of pretransplant, donor-specific IgM antibodies has no correlation with short-term and longterm renal graft outcome in allotransplantation (26). In fact, renal allotransplantation in spite of high levels of pretransplant IgM has been performed successfully in the context of ABO incompatibility using a strategy of partial IgM depletion and an immunosuppressive regimen aimed at inducing a state of accommodation (27,28), although accommodation has yet to be observed in a large animal xenograft model. Our initial experience using GalT-KO donors in a pig-to-baboon model of xenotransplantation suggests that the T cell-dependent IgG antibody response should be avoidable by strategies aimed at inducing T cell tolerance, as no humoral rejection was observed in renal xenografts that were co-transplanted with thymic xenografts (8).…”

Excellent long-term outcomes of ABO-incompatible kidney transplantation in children

“…However, this procedure is not used at present in our country since the use of Biosynsorb Column mentioned above was not approved by the National Health Insurance of Japan due to its significant expense. Therefore, in our present protocol, we use single PP as previously outlined [4].…”

“…Since 1994, a single plasmapheresis (PP) was used with a continuous flow blood cell separator on the same time schedule [4]. In all but the last session, the removed plasma was replaced by 3-5% albumin-containing solution and gamma globulin.…”

“…If an appropriate living donor is not available, a child may have to wait for a considerable period of time for a deceased donor. In this setting, blood group ABO incompatibility was regarded as a major obstacle in screening potential living donors [4].…”