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ABO incompatible kidney transplantations without splenectomy, using antigen-specific immunoadsorption and rituximab.

Gunnar Tydén·Gunilla Kumlien·Helena Genberg·John Sandberg·Torbjörn Lundgren·Ingela Fehrman
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Abstract

ABO incompatible kidney transplantations have previously only been performed after several preoperative sessions of plasmapheresis and splenectomy, with the conventional triple-drug immunosuppressive protocol being reinforced with antilymphocyte globulin and B-cell-specific drugs, such as cyclophosphamide or deoxyspergualine. We have designed a protocol without splenectomy, based on antigen-specific immunoadsorption, rituximab and a conventional triple-drug immunosuppressive protocol. The protocol calls for a 10-day pretransplantation conditioning period, starting with one dosage of rituximab and followed by full dose tacrolimus, mycophenolate mofetil and prednisolone. Antigen-specific immunoadsorption was performed on pretransplantation days -6, -5, -2 and -1. After the last session, 0.5 g/kg of intravenous immunoglobulin (IVIG) was administered. Postoperatively, three more apheresis sessions were given every third day. Furthermore, if there was a significant increase in the antibody titers, extra sessions were considered. Eleven patients have received transplants with this protocol. The ABO antibodies were readily removed by the antigen-specific immunoadsorption and were kept at a low level post-transplantation by further adsorptions. There were no side effects and all patients have normal renal transplant function. We conclude that after an infusion each of rituximab and IVIG, and antigen-specific immunoadsorption; blood group-incompatible renal transplantations can be performed with excellent results using standard immunosuppression and no splenectomy.

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ABO Blood-Group SystemAdsorptionAdultAgedAntibodies, MonoclonalAntibodies, Monoclonal, Murine-DerivedAntigensAntigens, CD20Antineoplastic AgentsB-LymphocytesBlood Component RemovalBlood Group IncompatibilityCreatinineFemaleHumansImmunoglobulins, IntravenousImmunosorbent TechniquesImmunosuppressive AgentsKidney TransplantationMaleMiddle AgedMycophenolic AcidPrednisoloneRituximabSplenectomyTacrolimusTime FactorsTransplantation ConditioningClinical TrialJournal Article

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Gunnar Tydén, Gunilla Kumlien, Helena Genberg, John Sandberg, Torbjörn Lundgren, Ingela Fehrman. 2005. ABO incompatible kidney transplantations without splenectomy, using antigen-specific immunoadsorption and rituximab.. https://doi.org/10.1111/j.1600-6143.2004.00653.x

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