Successful A1-to-O ABO-incompatible kidney transplantation after a preconditioning regimen consisting of anti-CD20 monoclonal antibody infusions, splenectomy, and double-filtration plasmapheresis

Sawada, Tokihiko; Fuchinoue, Shohei; Teraoka, Satoshi

doi:10.1097/00007890-200211150-00001

Cited by 128 publications

(90 citation statements)

References 9 publications

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“…However, all the evidence in humans was based on dosages of 375 mg/m 2 or over. Sawada et al reported that four doses of RIT at 375 mg/m 2 completely eliminated CD20 + B cells from the spleen in a renal transplant recipient [1]. Ramos et al showed that a single dose of RIT at 375 mg/m 2 , combined with plasmapheresis and intravenous immunoglobulin therapy, depleted most B cells, both CD20 + and CD79a + cells, from the spleen [9].…”

Section: Discussionmentioning

confidence: 99%

“…Rituximab (RIT; Chugai, Tokyo, Japan), a chimeric murine/human monoclonal antibody that binds to the CD20 antigen, has been employed as a component of desensitization protocols in renal transplant recipients, and for treatment of refractory rejection, which did not respond to initial treatment with high-dose steroids therapy, because of its potent B-cell elimination effect; the administration of RIT has provided excellent clinical outcomes [1][2][3][4][5][6]. Typically, a single dose of RIT at 375 mg/m 2 [2][3][4][5][6], which is known to lead to marked B-cell depletion in the peripheral blood and spleen [7][8][9], is administered instead of a splenectomy.…”

Section: Introductionmentioning

confidence: 99%

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Impact of low-dose rituximab on splenic B cells in ABO-incompatible renal transplant recipients

Toki¹,

Ishida²,

Horita³

et al. 2009

Transplant International

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Summary The purpose of this study was to assess the effect of a low‐dose rituximab (RIT) at <375 mg/m2 on B cells in the spleen and peripheral blood. Five renal transplant recipients received a single dose of RIT at 10, 15, 35, 150, or 300 mg/m2 3–13 days before transplantation. One patient who received the same immunosuppressive regimen except for RIT was also enrolled as a control. Splenectomy was performed at the time of transplantation in all patients. The B‐cell count in the peripheral blood was analysed with a fluorescence‐activated cell sorter using anti‐CD19 antibodies, and the B cells in the spleen were analysed by immunohistochemistry using anti‐CD20 and ‐CD79a antibodies. All but one dosage (10 mg/m2) of RIT completely eliminated B cells from the circulation within 30 days. Immunohistochemical examination of the spleen showed a marked reduction of B cells in the white pulps in all five recipients compared with that in the control patient. The observations in this study indicated that RIT has a potent effect of depleting B cells in the spleen and peripheral blood at low‐doses of <375 mg/m2.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of low-dose rituximab on splenic B cells in ABO-incompatible renal transplant recipients

Toki¹,

Ishida²,

Horita³

et al. 2009

Transplant International

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“…The rationale for splenectomy as a strategy for AMR derives historically from its use in adjunctive desensitization protocols in kidney transplantation. [219][220][221][222][223] There are multiple reports of splenectomy as successful rescue therapy in a small number of patients with refractory AMR in kidney transplantation. 218,221,224 There are no reports, to the best of our knowledge, of splenectomy in heart transplant recipients with AMR.…”

Section: Splenectomymentioning

confidence: 99%

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

Colvin¹,

Cook²,

Chang³

et al. 2015

Circulation

287

251

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“…El mantenimiento de niveles bajos de isoagluti ninas durante el periodo temprano del postrasplante es críti co para la seguridad del injerto y en el caso del paciente se evidenció leve rebote de isoagluti ninas en el día 4 (IgG 4 a 16) asociado a incremento de niveles de creati nina (1,2 a 1,7 mg%) (36) . La mayoría de pérdidas de injertos por rechazo mediado por anti cuerpos ocurre en los tres primeros meses del post-Tx; por tanto es importante estar atentos al rebote de tí tulos de anti cuerpos anti -ABO en esta etapa (7,13,23,35) . En nuestro caso, no se desarrolló rechazo mediado por anti cuerpos a pesar del rebote (36) , y gracias a la aféresis postrasplante instaurada prontamente de tres recambios plasmáti cos fue benefi ciosa la evolución.…”

Section: Discussionunclassified

Trasplante renal grupo sanguíneo ABO incompatible. Experiencia colaborativa inédita España y Perú

et al. 2017

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Resumen La incompatibilidad de grupo sanguíneo ABO y la sensibilización al HLA constituyen grandes barreras a vencer en pro de la óptima utilización de riñones de donante vivo. Describimos en nuestro medio el primer trasplante renal exitoso ABO incompatible en un paciente de 24 años, retrasplantado renal, altamente sensibilizado (PRA: 89%) y sin opción alguna en disponer de donantes cadavéricos ni familiares. Sin embargo, su único donante vivo HLA compatible era de grupo sanguíneo A incompatible con el grupo O del receptor. El paciente requirió de un régimen precondicionante consistente en recambios plasmáticos, rituximab, imunoglobulina y terapia inmunosupresora cuádruple, a fin de reducir los títulos elevados de isoaglutininas anti A de 1:128 a niveles de seguridad de 1:8, para el éxito del trasplante. Este fue realizado en Coordinación con la Unidad de Trasplante Renal del Hospital Clínic de Barcelona España (HCB). La ausencia de rechazo mediado por isoaglutininas muestra el potencial beneficio del protocolo al remover los anticuerpos anti grupo sanguíneo. A los dos años del trasplante, la función renal se mantiene estable con niveles de creatinina 1,5 mg%. Concluimos que el trasplante renal ABO incompatible (ABOi) es opción viable para pacientes cuyo único donante sea grupo sanguíneo incompatible, y entre nosotros representa esperanzadora fuente de órganos. Palabras clave: ABO Incompatible; Trasplante Renal; Acomodación; Anticuerpos anti HLA; Riesgo Inmunológico. Abstract ABO blood group incompatibility and HLA sensitization are major barriers that need to be overcome in order to make optimum use of kidneys from living donors possible. We report the first successful ABOincompatible kidney transplant in a 24-year old, highly sensitized (panel reactive antibodies (PRA) 89% kidney retransplantation patient, who lacked any option to get a cadaveric or family donor. However, the patient's sole HLA-compatible living donor had group A blood incompatible with the recipient's O blood group. The patient required a pre-conditioning regime that consisted of plasma exchange, rituximab, immunoglobulin, and quadruple immunosuppressive therapy in order to reduce high titers of anti-A isoagglutinins from 1:128 to a safe level of 1:8, for successful transplant. This was performed in coordination with the Renal Transplant Unit of Hospital Clinic de Barcelona (HCB), Spain. Absence of rejection mediated by isoagglutinins shows the potential benefit of a protocol consisting in removing antibodies from the anti-blood group. Two years after transplantation, the kidney function remains stable, with creatinine levels of 1.5 mg%. We conclude that an ABO-incompatible kidney transplant is a viable option for patients whose only donor has blood of an incompatible blood group and for us this represents a hope-inspiring source of organs.

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Successful A1-to-O ABO-incompatible kidney transplantation after a preconditioning regimen consisting of anti-CD20 monoclonal antibody infusions, splenectomy, and double-filtration plasmapheresis

Abstract: A preconditioning regimen consisting of rituximab infusions and a splenectomy is a useful new strategy for performing ABO-incompatible kidney transplantations when the conventional preconditioning regimen does not work.

Cited by 128 publications

References 9 publications

Impact of low-dose rituximab on splenic B cells in ABO-incompatible renal transplant recipients

Impact of low-dose rituximab on splenic B cells in ABO-incompatible renal transplant recipients

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

Trasplante renal grupo sanguíneo ABO incompatible. Experiencia colaborativa inédita España y Perú

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