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Plasma exchange conditioning for ABO-incompatible renal transplantation
J L Winters1, J M Gloor, A A Pineda
1Department of Laboratory Medicine and Pathology, Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. winters.jeffrey@mayo.edu
Journal of Clinical Apheresis
|July 27, 2004
Summary
ABO-incompatible kidney transplants from living donors can expand organ supply. Mayo Clinic
Area of Science:
- Nephrology
- Transplantation Immunology
Background:
- Limited deceased donor kidney supply necessitates alternative strategies.
- ABO-incompatible living donor kidney transplantation is an option to expand donor pool.
Purpose of the Study:
- To present the Mayo Clinic's experience with ABO-incompatible living donor kidney transplantation.
- To evaluate transplant outcomes and rejection rates in this patient population.
Main Methods:
- Patients with ABO-incompatible living donors underwent pre-transplant conditioning with plasma exchange and intravenous immunoglobulin.
- Splenectomy was performed during transplant surgery.
- Post-transplant immunosuppression included anti-T lymphocyte antibody, tacrolimus, mycophenolate mofetil, and prednisone.
Main Results:
- Twenty-six ABO-incompatible kidney transplants were performed with no hyperacute rejection.
- Patient and graft survival rates were 92% and 85% at a mean follow-up of 400 days.
- Antibody-mediated rejection occurred in 46% of patients but was reversed in 83% with treatment; pre-transplant plasma exchange significantly reduced isoagglutinin titers.
Conclusions:
- Pre-transplant plasma exchange conditioning is effective in preparing patients for ABO-incompatible kidney transplantation.
- Antibody-mediated rejection remains a common post-transplant complication, potentially impacting allograft survival.
- Further controlled trials are needed to optimize conditioning protocols for ABO-incompatible renal transplants.