A Successful Case of a High Anti A/B Antibody Titer ABO Incompatible Kidney Transplantation Patient Who Received a Kidney from a Hepatitis B Carrier

Jin Ho Lee; Han Sae Kim; Dong Yeol Lee; Joon Seok Oh; Yong Hun Sin; Joong Kyung Kim; Jong Hyun Park; Kill Huh; Jong In Park

doi:10.4285/jkstn.2016.30.4.184

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Lee, Kim, Lee, Oh, Sin, Kim, Park, Huh, and Park: A Successful Case of a High Anti A/B Antibody Titer ABO Incompatible Kidney Transplantation Patient Who Received a Kidney from a Hepatitis B Carrier

Case Report

J Korean Soc Transplant 2016;30(4):184-189.

Published online: 19 January 2016

DOI: https://doi.org/10.4285/jkstn.2016.30.4.184

A Successful Case of a High Anti A/B Antibody Titer ABO Incompatible Kidney Transplantation Patient Who Received a Kidney from a Hepatitis B Carrier

Jin Ho Lee, M.D.¹, Han Sae Kim, M.D.¹, Dong Yeol Lee, M.D.¹, Joon Seok Oh, M.D.¹, Yong Hun Sin, M.D.¹, Joong Kyung Kim, M.D.^1,, Jong Hyun Park, M.D.², Kill Huh, M.D.², Jong In Park, M.D.³

¹Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea

²Department of Internal Medicine, General Surgery, Bong Seng Memorial Hospital, Busan, Korea

³Department of Internal Medicine and Laboratory Medicine, Bong Seng Memorial Hospital, Busan, Korea

Corresponding author: Joong Kyung Kim Department of Internal Medicine, Bong Seng Memorial Hospital, 401 Jungang-daero, Dong-gu, Busan 48775, Korea Tel: 82-51-664-4000, Fax: 82-51-664-4229 E-mail: kidney119@hotmail.com

Received 20 May 2016 Revised 7 December 2016 Accepted 8 December 2016

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

Kidney transplantation (KTP) lowers the mortality and morbidity of patients with end-stage renal disease. Post-transplantation infection and antibody mediated rejection (AMR) are the most common complications. Hepatitis B surface antigen (HBsAg) positive carrier donors and high anti A/B antibody titer ABO incompatible KTP could lead to recipient hepatitis B virus (HBV) infection and AMR. Here, we report a case of successful KTP in a 41-year-old male with a high titer of ABO incompatible and HBsAg positive donor. He underwent seven rounds of plasmapheresis, low dose intravenous immunoglobulin and rituximab treatment to inhibit antibody production and remove antibodies from the serum, after which he was administered anti-viral agent for HBV prophylaxis. The recipient maintained successful allograft function for 6 months after transplantation; therefore, we report that desensitization and anti-viral treatment achieved successful outcome in a 1:512 anti A/B antibody titer ABO incompatible and hepatitis B carrier donor KTP.

Keywords: ABO incompatibility, Hepatitis B surface antigen positive donor, Kidney transplantation

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Fig. 1.

Changes of creatinine and urine volume before and after transplantation. Abbreviations: DSA, donor specific antibody; PRA, panel reactive antibody; CMx, cross matching; FCM, flow cytometry; MFI, mean fluorescence intensity; HBV, hepatitis B virus; QD, once a day; QOD, every other day; POD, postoperation day; OP, operation.

Fig. 2.

Change of anti A/B Ab titer before and after transplantation. Abbreviations: PP, plasmapheresis; IVIG, intravenous immunoglobulin; RTX, rituximab; Ab, antibody; POD, postoperation day.

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