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Successful ABO-incompatible kidney transplantations without splenectomy using antigen-specific immunoadsorption and
Gunnar Tydén1, Gunilla Kumlien, Ingela Fehrman
1Department of Transplantation Surgery, Karolinska Institute at Huddinge University Hospital, Stockholm, Sweden.
Transplantation
|September 16, 2003
Summary
ABO-incompatible kidney transplants are now feasible without splenectomy using antigen-specific immunoadsorption and standard immunosuppression. This novel protocol effectively removes ABO-antibodies, ensuring normal renal transplant function in patients.
Area of Science:
- Nephrology
- Immunology
- Transplantation Medicine
Background:
- ABO-incompatible kidney transplantation traditionally required splenectomy and extensive immunosuppression.
- Previous protocols involved unspecific plasmapheresis and B-cell specific drugs.
- This study evaluates a new protocol avoiding splenectomy.
Purpose of the Study:
- To assess the efficacy and safety of a novel protocol for ABO-incompatible kidney transplantation.
- To determine if splenectomy can be omitted using antigen-specific immunoadsorption and standard immunosuppression.
Main Methods:
- A 10-day pretransplant conditioning regimen including rituximab, tacrolimus, mycophenolate mofetil, and prednisolone.
- Antigen-specific immunoadsorption performed pre- and post-transplant to remove ABO-antibodies.
- Intravenous immunoglobulin administration post-immunoadsorption.
Main Results:
- Four ABO-incompatible kidney transplants were successfully performed.
- Antigen-specific immunoadsorption effectively reduced ABO-antibodies.
- All patients exhibited normal renal transplant function with no reported side effects.
Conclusions:
- ABO-incompatible kidney transplantation can be safely performed without splenectomy.
- The protocol utilizes rituximab, intravenous immunoglobulin, and antigen-specific immunoadsorption.
- Standard immunosuppressive regimens are sufficient with this approach.