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ABO incompatible kidney transplantations without splenectomy, using antigen-specific immunoadsorption and rituximab
Gunnar Tydén1, Gunilla Kumlien, Helena Genberg
1Department of Transplantation Surgery, Karolinksa University Hospital, Huddinge, Stockholm, Sweden. gunnar.tyden@kus.se
Summary
This study introduces a novel protocol for ABO incompatible kidney transplants, eliminating the need for splenectomy. The new method uses antigen-specific immunoadsorption and rituximab, achieving excellent patient outcomes with standard immunosuppression.
Area of Science:
- Nephrology
- Immunology
- Transplantation Science
Background:
- ABO incompatible kidney transplantation traditionally requires splenectomy and intensive immunosuppression.
- Previous protocols involved plasmapheresis, splenectomy, and reinforced immunosuppressive agents like antilymphocyte globulin and B-cell-specific drugs.
Purpose of the Study:
- To design and evaluate a novel protocol for ABO incompatible kidney transplantation that avoids splenectomy.
- To assess the efficacy and safety of antigen-specific immunoadsorption, rituximab, and standard immunosuppression in this patient population.
Main Methods:
- A 10-day pretransplantation conditioning regimen included rituximab, tacrolimus, mycophenolate mofetil, and prednisolone.
- Antigen-specific immunoadsorption was performed on specific pretransplantation days, followed by intravenous immunoglobulin (IVIG).
- Postoperative apheresis sessions were administered, with additional sessions based on antibody titer monitoring.
Main Results:
- Eleven patients received kidney transplants using the new protocol.
- Antigen-specific immunoadsorption effectively removed ABO antibodies, maintaining low levels post-transplantation.
- All patients demonstrated normal renal transplant function with no reported side effects.
Conclusions:
- Splenectomy can be omitted in ABO incompatible kidney transplantation.
- The protocol utilizing rituximab, IVIG, and antigen-specific immunoadsorption allows for successful transplantation with standard immunosuppression.
- This approach offers excellent results for blood group-incompatible renal transplants.