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ABO-incompatible pediatric kidney transplantation in a single-center trial
T Ohta1, H Kawaguchi, M Hattori
1Department of Pediatric Nephrology, Tokyo Women's Medical College, Japan.
Pediatric Nephrology (Berlin, Germany)
|February 2, 2000
Summary
Pediatric kidney transplants from ABO-incompatible donors achieved 100% patient and graft survival. Preoperative isoagglutinin reduction and splenectomy are key to successful outcomes in children.
Area of Science:
- Nephrology
- Immunology
- Pediatric Surgery
Background:
- Living-related ABO-incompatible kidney transplantation in children presents unique immunological challenges.
- Managing isoagglutinin titers is crucial to prevent hyperacute and vascular rejection.
- Established protocols for adult ABO-incompatible transplants may require adaptation for pediatric recipients.
Purpose of the Study:
- To evaluate the efficacy and safety of a specific immunosuppressive protocol for pediatric ABO-incompatible kidney transplantation.
- To assess patient and graft survival rates in this challenging pediatric cohort.
- To determine the impact of preoperative isoagglutinin reduction and splenectomy on transplant outcomes.
Main Methods:
- Ten pediatric patients underwent living-related ABO-incompatible kidney transplantation.
- Preoperative management included plasmapheresis and/or immunoadsorption to reduce isoagglutinin titers.
- Immunosuppression involved a combination of methylprednisolone, calcineurin inhibitors (cyclosporine or tacrolimus), azathioprine, anti-lymphocyte globulin, and/or deoxyspergualin.
- Splenectomy was performed concurrently with transplantation in all patients.
Main Results:
- Excellent patient and graft survival rates of 100% were observed at a median follow-up of 65 months.
- Post-transplantation isoagglutinin titers remained below 1:32 in most patients, with no uncontrollable vascular rejections.
- Despite intensive immunosuppression, cytomegalovirus infection occurred in only three patients and was successfully treated.
Conclusions:
- Preoperative reduction of isoagglutinin titers is effective in preventing rejection in pediatric ABO-incompatible kidney transplants.
- The combination of preoperative isoagglutinin reduction, splenectomy, and a robust immunosuppressive regimen leads to successful long-term outcomes in children.
- This approach offers a viable option for pediatric kidney transplantation when ABO-compatible donors are unavailable.