ABO-incompatible living related donor kidney transplantation: report of two cases

The courses of two recipients of ABO-incompatible HLA-identical living related donor kidney transplants are described, the first an A into O and the second a B into A. Both patients were prepared by a month of preoperative azathioprine and a week of plasmapheresis to reduce isohemagglutinin titers in one to 1:2 and in the other to 0 at the time of transplant. Both had early mild steroid-reversible rejections, and the first patient has had an uneventful subsequent course 20 months postgrafting on low-dose cyclosporine and prednisone. The second patient developed a further immunologic event at 1 month that may have been isohemagglutinin mediated or may have been rejection but subsided with OKT3 therapy and plasmapheresis. She lost her graft at 5 months despite normal function during attempts to repair a ureteric fibrosis. Neither patient had donor-specific transfusion or splenectomy. This approach is feasible and should be considered for those patients having related but ABO-incompatible donors.