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KMID : 0361120090230010071
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Korean Journal of Transplantation
2009 Volume.23 No. 1 p.71 ~ p.76
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ABO Blood Group Incompatible Living Donor Kidney Transplantation without Splenectomy
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Kong Jin-Min
Lee Dong-Ryeol
Jeong Joon-Heon
Choi Jae-Ho
Lee Jeong-Oh
Lee Wha Rhim
Kim Byung-Chang
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Abstract
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Background: Serious organ shortage necessitates ABO incompatible (ABOi) kidney transplantation (KT). Recent reports utilizing rituximab instead of splenectomy and tacrolimus (FK)-based triple immunosuppressants showed excellent graft outcome.
Methods and Results: Thirteen cases of ABOi living donor KT have been performed since Feb. 2007 in our center. Donor and recipient blood group was B to O (n=5), A1 to O (2), AB to B (2), AB to A1 (1), A1 to B (2) and B to A1 (1). Rituximab was given at 4 weeks before transplantation. Plasmapheresis (PP) was initiated at 7∼14 days before transplantation with concurrent immunosuppressants. The number of pretransplant PP was 5.7±1.4. Posttransplant PP was also performed in 6 patients with higher initial titer of ABO antibody (IgG ≥256; n=2), rapidly rising antibody titer during the critical period of 2 weeks posttransplantation (n=2), or increase in serum creatinine during the critical period while awaiting pathology report of graft biopsy (n=2). Mean number of posttransplant PP in these 6 patients was 2.2±1.3. Median IgG anti-ABO antibody titer before precondition, at transplantation, at 2 weeks and at 6 months was 64 (8∼512), 2 (1∼8), 2 (1∼16) and 6 (1∼16), respectively. IgM titer at corresponding time point was 16 (2∼128). 1 (1∼1), 1 (1∼2) and 1.5 (1∼4), respectively. Median follow up was 8 (5∼27) months. No patient or graft was lost. No patient developed acute humoral rejection. Graft function remained stable with latest serum creatinine 1.2±0.3 mg/dl.
Conslusions: ABOi living donor KT without splenectomy can be safely performed with the use of current preconditioning and immunosuppressive regimen, and is therefore a valuable option for expanding donor pool and should be actively performed in Korea.
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KEYWORD
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ABO incompatible kidney transplantation, Antibody mediated rejection, Rituximab
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