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Title: ABO incompatible renal transplantation without antibody removal using conventional immunosuppression alone.
Epworth Authors: Cohney, Solomon (Shlomo)
Other Authors: Masterson, Rosemary
Hughes, Peter
Walker, R. G.
Hogan, C.
Haeusler, Michael
Robertson, A. R.
Miller, Robert
Suh, Nancy
Keywords: ABO Blood-Group System
Blood Group Incompatibility
Follow-Up Studies
Glomerular Filtration Rate
Graft Rejection
Drug Therapy
Graft Survival
Immunosuppressive Agents
Therapeutic Use
Kidney Failure, Chronic
Kidney Function Tests
Kidney Transplantation
Postoperative Complications
Prospective Studies
Risk Factors
Middle Aged
Renal Transplantation
ABO Compatible Transplantation
ABO Incompatible Transplantation
Antibody-Mediated Rejection
Anti-Blood Group Antibodies
Acute Cellular Rejection
UroRenal, Vascular Clinical Institute, Epworth HealthCare, Victoria, Australia
Department of Nephrology, Epworth HealthCare, Richmond, Victoria, Australia.
Department of Gastroenterology, Epworth HealthCare, Richmond, Victoria, Australia.
Issue Date: Dec-2014
Publisher: Wiley
Citation: Am J Transplant. 2014 Dec;14(12):2807-13.
Abstract: ABO incompatible living donor renal transplantation (ABOi) can achieve outcomes comparable to ABO compatible transplantation (ABOc). However, with the exception of blood group A2 kidneys transplanted into recipients with low titer anti-A antibody, regimens generally include antibody removal, intensified immunosuppression and splenectomy or rituximab. We now report a series of 20 successful renal transplants across a range of blood group incompatibilities using conventional immunosuppression alone in recipients with low baseline anti-blood group antibody (ABGAb) titers. Incompatibilities were A1 to O (3), A1 to B (2), A2 to O (2), AB to A (2), AB to B (1), B to A1 (9), B to O (1); titers 1:1 to 1:16 by Ortho. At 36 months, patient and graft survival are 100%. Antibody-mediated rejection (AbMR) occurred in one patient with thrombophilia and low level donor-specific anti-HLA antibody. Four patients experienced cellular rejection (two subclinical), which responded to oral prednisolone. This series demonstrates that selected patients with low titer ABGAb can undergo ABOi with standard immunosuppression alone, suggesting baseline titer as a reliable predictor of AbMR. This reduces morbidity and cost of ABOi for patients with low titer ABGAb and increases the possibility of ABOi from deceased donors.
DOI: 10.1111/ajt.12920
PubMed URL:
ISSN: 1600-6143
Journal Title: American Journal of Transplantation
Type: Journal Article
Affiliated Organisations: Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
The Alfred Hospital, Prahran, Victoria, Australia.
Department of Medicine, Monash University, Clayton, Victoria, Australia.
Department of Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Medicine, NorthWest Academic Centre, University of Melbourne, St. Albans, Victoria, Australia.
Type of Clinical Study or Trial: Case Series and Case Reports
Appears in Collections:UroRenal, Vascular

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