An Experience of ABO-incompatible Kidney Transplantation Using Plasmapheresis and Anti-CD20 Monoclonal Antibody

Hee-Won Moon; Yeo-Min Yun; Mina Hur; Jung Hwan Park; Hae Won Lee; Seong-Hwan Chang; Ik Jin Yun

doi:10.3343/kjlm.2009.29.6.585

Journal List > Korean J Lab Med > v.29(6) > 1011602

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Moon, Yun, Hur, Park, Lee, Chang, and Yun: An Experience of ABO-incompatible Kidney Transplantation Using Plasmapheresis and Anti-CD20 Monoclonal Antibody

Case Report

Korean J Leg Med 2009;29(6):585-588.

Published online: 14 January 2009

DOI: https://doi.org/10.3343/kjlm.2009.29.6.585

An Experience of ABO-incompatible Kidney Transplantation Using Plasmapheresis and Anti-CD20 Monoclonal Antibody

Hee-Won Moon, M.D.¹, Yeo-Min Yun, M.D.¹, Mina Hur, M.D.¹, Jung Hwan Park, M.D.², Hae Won Lee, M.D.³, Seong-Hwan Chang, M.D.³, Ik Jin Yun, M.D.³

¹Departments of Laboratory Medicine, Internal, Seoul, Korea

²Medicine, and Surgery, Seoul, Korea

³Konkuk University School of Medicine, Seoul, Korea

Corresponding author: Mina Hur, M.D. Department of Laboratory Medicine, Konkuk University School of Medicine, Konkuk University Hospital, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea Tel: +82-2-2030-5581, Fax: +82-2-2636-6764 E-mail: dearmina@hanmail.net

Revised 18 July 20093 August 2009 Accepted 2 September 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Due to an extreme shortage of cadaveric kidneys, many centers in Japan successfully performed ABO-incompatible kidney transplantations using plasmapheresis, splenectomy and immunosuppression. Recently, a protocol including anti-CD20 monoclonal antibody (rituximab) and antigen-selective immunoadsorption has been used for ABO-incompatible transplantation in Europe. In Korea, ABO-incompatible kidney transplantation has been rarely performed. We report an experience of successful ABO-incompatible kidney transplantation using plasmapheresis and rituximab. The patient was a 32-yr-old female suffering from chronic renal failure, and her blood type was O, Rh+. The donor was her husband, and his blood type was B, Rh+. A combination therapy including 5 times of plasmapheresis starting from 10 days before transplantation with 2-day interval, intravenous gammaglobulin, rituximab at 2 weeks before transplantation and potent immunosuppression successfully decreased the titers of anti-A and anti-B antibodies to 1:2 and 1:1, respectively. The kidney transplantation was successful without any sign of hyperacute or acute rejection.

Keywords: ABO-incompatible kidney transplantation, Plasmapheresis, Anti-CD20 antibody, Intravenous gammaglobulin, Immunosuppression

REFERENCES

1.Ishida H., Koyama I., Sawada T., Utsumi K., Murakami T., Sannomiya A, et al. Anti-AB titer changes in patients with ABO incompatibility after living related kidney transplantations: survey of 101 cases to determine whether splenectomies are necessary for successful transplantation. Transplantation. 2000. 70:681–5.

2.Takahashi K. Accommodation in ABO-incompatible kidney transplantation: why do kidney grafts survive? Transplant Proc. 2004. 36:193S–6S.

3.Takahashi K., Saito K. Present status of ABO-incompatible kidney transplantation in Japan. Xenotransplantation. 2006. 13:118–22.

4.Takahashi K., Takahara S., Uchida K., Oshima S., Toma H., Sonoda T. Successful results after 3 years' tacrolimus immunosuppression in ABO-incompatible kidney transplantation recipients in Japan. Transplant Proc. 2002. 34:1604–5.

5.Tanabe K., Takahashi K., Sonda K., Tokumoto T., Ishikawa N., Kawai T, et al. Long-term results of ABO-incompatible living kidney transplantation: a single-center experience. Transplantation. 1998. 65:224–8.

6.Tyden G., Donauer J., Wadstrom J., Kumlien G., Wilpert J., Nilsson T, et al. Implementation of a Protocol for ABO-incompatible kidney transplantation—a three-center experience with 60 consecutive transplantations. Transplantation. 2007. 83:1153–5.

7.Tyden G., Kumlien G., Genberg H., Sandberg J., Lundgren T., Fehrman I. ABO incompatible kidney transplantations without splenectomy, using antigen-specific immunoadsorption and rituximab. Am J Transplant. 2005. 5:145–8.

8.Wilpert J., Geyer M., Teschner S., Schaefer T., Pisarski P., Schulz-Huotari C, et al. ABO-incompatible kidney transplantation-proposal of an intensified apheresis strategy for patients with high initial isoagglutinine titers. J Clin Apher. 2007. 22:314–22.

9.Kong JM., Lee DR., Jeong JH., Choi JH., Lee JO., Lee WR, et al. ABO blood group incompatible living donor kidney transplantation without splenectomy. J Korean Soc Transplant. 2009. 23:71–6. (공진민, 이동렬, 정준헌, 최재호, 이정오, 이화림등. 비장적출을하지않은ABO 혈액형 부적합 생체 신장이식 경험. 대한이식학회지 2009;23:71-6.).

10.Roback JD, Combs MR, editors. Technical manual. 16th ed.Bethesda: American Association of Blood Banks;2008.

11.Szczepiorkowski ZM., Bandarenko N., Kim HC., Linenberger ML., Marques MB., Sarode R, et al. Guidelines on the use of therapeutic apheresis in clinical practice: evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher. 2007. 22:106–75.

12.Donauer J., Wilpert J., Geyer M., Schwertfeger E., Kirste G., Drognitz O, et al. ABO-incompatible kidney transplantation using antigenspecific immunoadsorption and rituximab: a single center experience. Xenotransplantation. 2006. 13:108–10.

13.Sonnenday CJ., Ratner LE., Zachary AA., Burdick JF., Samaniego MD., Kraus E, et al. Preemptive therapy with plasmapheresis/intravenous immunoglobulin allows successful live donor renal transplantation in patients with a positive cross-match. Transplant Proc. 2002. 34:1614–6.

14.Kim HR., Lee JN., Kim YH. HLA cross-match negative conversion by therapeutic plasmapheresis in a patient with positive HLA crossmatch. Korean J Lab Med. 2003. 23:439–42. (김혜란, 이정녀, 김영훈. 치료적혈장교환술로HLA 교차시험양성에서음성으로전환된 1예. 대한진단검사의학회지 2003;23:439-42.).

15.Jordan SC. Management of the highly HLA-sensitized patient. A novel role for intravenous gammaglobulin. Am J Transplant. 2002. 2:691–2.

16.Stussi G., Huggel K., Lutz HU., Schanz U., Rieben R., Seebach JD. Isotype-specific detection of ABO blood group antibodies using a novel flow cytometric method. Br J Haematol. 2005. 130:954–63.

17.Kumlien G., Wilpert J., Safwenberg J., Tyden G. Comparing the tube and gel techniques for ABO antibody titration, as performed in three European centers. Transplantation. 2007. 84:S17–9.

Fig. 1.

Titers of anti-A and anti-B antibodies and creatinine levels before and after ABO-incompatible kidney transplantation using plasmapheresis and rituximab.

TOOLS

Similar articles