Successful ABO-Incompatible Kidney Transplantation with Antibody Removal and Standard Immunosuppression

Flint, Shaun; Walker, Rowan G.; Hogan, Chris; Haeusler, Michael; Robertson, Amanda; Francis, D. M. A.; Millar, Robert; Finlay, Moira; Landgren, Anthony; Cohney, Solomon

doi:10.1111/j.1600-6143.2011.03464.x

Cited by 104 publications

(130 citation statements)

References 26 publications

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“…Flint et al (13) recently reported their prospective, observational experience with 37 ABOincompatible transplant recipients (52 contemporaneous ABO-compatible recipients acted as a comparator group). They found a BK viremia rate of 13% but no cases of BKVAN in the ABO-incompatible group (compared with 19% and one case of BKVAN in the ABO-compatible group).…”

Section: Discussionmentioning

confidence: 99%

“…Risks and benefits of performing transplantation across the blood-group barrier are well documented (6-9), but a link between ABO-incompatible kidney transplantation and risk for BKVAN is contentious. Some groups have observed a higher risk for BK viremia or nephropathy (10)(11)(12), whereas others have not (8,13). The implication is that ABO-incompatible kidney recipients may be at greater risk for development of BK viremia or nephropathy because of increased intensity of induction protocols and subsequent immunosuppressant burden (both maintenance and treatment of cellularand antibody-mediated rejections).…”

Section: Introductionmentioning

confidence: 99%

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Incidence and Outcomes of BK Virus Allograft Nephropathy among ABO- and HLA-Incompatible Kidney Transplant Recipients

Sharif

Alachkar²,

Bagnasco³

et al. 2012

Clinical Journal of the American Society of Nephrology

106

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SummaryBackground and objectives ABO-incompatible kidney transplant recipients may have a higher incidence of BK virus allograft nephropathy (BKVAN) compared with ABO-compatible recipients. It is unclear whether HLAincompatible recipients share this risk or whether this phenomenon is unique to ABO-incompatible recipients.Design, setting, participation, & measurements This study analyzed adult incompatible kidney transplant recipients from 1998 to 2010 (62 ABO-incompatible and 221 HLA-incompatible) and identified patients in whom BKVAN was diagnosed by biopsy (per protocol or for cause). This was a retrospective analysis of a prospectively maintained database that compared BKVAN incidence and outcomes between ABO-and HLA-incompatible recipients, respectively. BKVAN link to rejection and graft accommodation phenotype were also explored. The Johns Hopkins Institutional Review Board approved this study.Results Risk for BKVAN was greater among ABO-incompatible than HLA-incompatible patients (17.7% versus 5.9%; P=0.008). Of BKVAN cases, 42% were subclinical, diagnosed by protocol biopsy. ABO-incompatibility and age were independent predictors for BKVAN on logistic regression. C4d deposition without histologic features of glomerulitis and capillaritis (graft accommodation-like phenotype) on 1-year biopsies of ABO-incompatible patients with and without BKVAN was 40% and 75.8%, respectively (P=0.04). Death-censored graft survival (91%) and serum creatinine level among surviving kidneys (1.8 mg/dl) were identical in ABO-and HLAincompatible patients with BKVAN (median, 1399 and 1017 days after transplantation, respectively).Conclusions ABO-incompatible kidney recipients are at greater risk for BKVAN than HLA-incompatible kidney recipients. ABO-incompatible recipients not showing the typical graft accommodation-like phenotype may be at heightened risk for BKVAN, but this observation requires replication among other groups.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence and Outcomes of BK Virus Allograft Nephropathy among ABO- and HLA-Incompatible Kidney Transplant Recipients

Sharif

Alachkar²,

Bagnasco³

et al. 2012

Clinical Journal of the American Society of Nephrology

106

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“…Los centros evalúan diversas técnicas de determinación de isoagluti ninas, dado que su exacta medición es determinante para el monitoreo de la desensibilización (32) . Los tí tulos iníciales de anti cuerpos naturales anti -A2 (Ig G 1/128, Ig M 1/128) presentes en el paciente, requerían un número mayor de sesiones de recambio plasmáti co para alcanzar niveles de seguridad aceptables previo al trasplante (menor de 1/8) (33) . La mayoría de centros identi fi ca un nivel de tí tulo de corte para exclusión de candidatos potenciales (9) y eligen por ejemplo como 1/8 el límite superior aceptable para el día del trasplante.…”

Section: Discussionunclassified

“…La individualización de los protocolos de desensibilización minimizando el núme-ro de sesiones de recambios plasmáti cos es la tendencia recomendable (9) . Actualmente, evitar la esplenectomía es relevante en los protocolos, por las complicaciones que conlleva, y solo se reserva para un pequeño número de pacientes como terapia de rescate en rechazos mediados por anti cuerpos de intensidad severa (5,33) . La plasmaféresis más que la inmunoadsorción es recomendada sobre todo para pacientes sensibilizados a fi n de remover los anti cuerpos anti -HLA y los anti cuerpos anti -ABO, como en nuestro caso (13,26,32,37) .…”

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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“…Bu nedenle transplant sonrası dönemde primer hastalık nüksü veya rejeksiyon gelişim riski yüksek olan gruplar özellikle belirlenmeli ve gerekli önlemler (6). ABO uyumsuzluğunda genel yaklaşım transplant öncesi 2-4 seans plazmaferez, sonrasında splenektomi veya rituksimab+İVİG uygulanmasıdır (7)(8)(9). İmmünadsorbsiyon işlemi spesifik olarak Anti-A ve Anti-B antikorlarını uzaklaştırdığı için PE tedavisine göre daha yararlıdır (10).…”

Section: Introductionunclassified

Plasmapheresis Therapy in Renal Transplant Patients

Güngör¹,

Tatar²,

Töz³

2013

turk Neph Dial Transpl

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ÖZKlinik pratikte, plazmaferez tedavisi dolaşan immünkompleksler, endotoksinler ve kolesterol içeren lipoproteinler gibi büyük molekül ağırlıklı maddeleri plazmadan temizlemek için kullanılmaktadır. Plazmaferez tedavisi romatoloji, onkoloji, dermatoloji ve nefrolojide belli başlı bazı hastalıkların tedavisinde fayda sağlamaktadır. Son dönem böbrek yetmezliğinin en seçkin tedavi yöntemi böbrek naklidir. Böbrek nakli sonrası dönemde gelişen akut-kronik rejeksiyonlar ve primer böbrek hastalığının nüksü greft sağ kalım süresini kısaltmaktadır. Plazmaferez tedavisi böbrek nakli hastalarında da transplant öncesi ve sonrası dönemde; ABO uyuşmazlığı, yüksek sensitize hastalar, akut-kronik humoral rejeksiyon, tekrarlayan glomerülonefrit ve trombotik mikroanjiyopati durumlarında kullanılabilir. ANAHTAR sÖZcÜklER: Böbrek nakli, Rejeksiyon, Plazmaferez AbsTRAcTIn clinical practice, plasmapheresis is utilized to remove circulating immune complexes, endotoxins and high molecular weight molecules such as lipoproteins containing cholesterol. It is useful in certain diseases in rheumatology, oncology, dermatology and nephrology. Renal transplantation is the most exclusive treatment modality in end stage renal failure. Acute and chronic rejections along with the recurrence of the primary kidney disease at the post-transplant period shorten graft survival. Plasmapheresis treatment can be used both at the pre-and post-transplant period in cases of ABO incompatibility, highly sensitized patients, acute and chronic rejections, recurring glomerulonephritis and thrombotic microangiopathies.

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Successful ABO-Incompatible Kidney Transplantation with Antibody Removal and Standard Immunosuppression

Abstract: ABO-incompatible (ABOi) kidney transplantation is an established therapy, though its implementation to date has been in part limited

Cited by 104 publications

References 26 publications

Incidence and Outcomes of BK Virus Allograft Nephropathy among ABO- and HLA-Incompatible Kidney Transplant Recipients

Incidence and Outcomes of BK Virus Allograft Nephropathy among ABO- and HLA-Incompatible Kidney Transplant Recipients

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

Plasmapheresis Therapy in Renal Transplant Patients

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