Successful ABO-incompatible kidney transplantations without splenectomy using antigen-specific immunoadsorption and rituximab

Abstract

We conclude that after one infusion each of rituximab and intravenous immunoglobulin and antigen-specific immunoadsorption, blood-group-incompatible renal transplantations can be performed with standard immunosuppression and without splenectomy.

Inadvertent cadaver kidney transplantation across the ABO barrier: a case report

“…The fact that this ABO-incompatible kidney was not acutely rejected but survived and functioned mid-term may be due to the low titre of natural anti-A antibodies, detected in the pre-transplantation serum. The case presented here, also isolated, indicates that lowtitre patients might not need intensive antibody removal therapy or immuno-absorption [18,19,21] and confirms the importance of reducing the pre-transplantation anti-A titre to 8 or below, by plasmapheresis, for a good outcome of ABO-incompatible kidney transplantation.…”

“…The patients that had received transplants required a more potent immunosuppression, often accompanied by splenectomy and plasmapheresis or immunoadsorption, to reduce A,B antibody titre [14]. Complete overviews and singlecentre studies on ABO incompatibility in solid-organ transplantation have been published [16,17,18,19]. In this letter we report on a patient of blood group B who was inadvertently given a kidney from a cadaver donor of blood group A 1 .…”

“…No history of previous blood components was reported. On September 6 th , 1997 the patient was selected for kidney transplantation according to the NITp algorithm, based on ABO identity, HLA compatibility, age matching and waiting time [18,20], and was given a kidney from a donor typed as blood group A 1 and HLA-A2;B8,61;DR3, 11. The immunosuppressive regimen of the patient consisted of tacrolimus · 2), azathioprine (100 mg), and methylprednisolone (from 12 mg to 4 mg in 2 months).…”

Immunogenicity of human embryonic stem cells

“…Use of anti-B-cell agents has proven efficacious in the treatment of B cell non-Hodgkin´s lymphoma (Maloney et al 1994;Coiffier et al 1998) and in various autoimmune diseases (Tsokos 2004). In the future, Rituximab might find a role in complementing the routine immunosuppressive arsenal, since it has been used successfully as induction therapy (Tydén et al 2003;Sonnenday et al 2004;Tydén et al 2005) and for treatment of allograft rejection (Becker et al 2004). Adding Rituximab to the conventional immunosuppression regime has also made it possible to transplant kidneys between ABO-incompatible individuals (Tydén et al 2005).…”

Ist die konventionelle Spendernephrektomie zur Nierenlebendspende noch zeitgemäß?

“…Im Rahmen der Verwandtenspende ist zudem eine gute HLA-Übereinstimmung von Spender und Empfänger zu erwarten. Die ABO-inkompatible Nierenlebendspende resultiert durch die Anwendung einer Immunadsorptionsbehandlung in Kombination mit einem monoklonalen anti-CD20-Antikörper in einer vergleichbaren Transplantatfunktion [7].…”