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Successful living donor renal transplantation despite ABO incompatibility and a positive crossmatch
Author(s) -
Kayler Liise K.,
Colombe Beth,
Farber John L.,
LaCava Deborah,
Dafoe Donald C.,
Burke James F.,
Francos George C.,
Ratner Lloyd E.
Publication year - 2004
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2004.00259.x
Subject(s) - medicine , plasmapheresis , abo blood group system , transplantation , kidney transplantation , histocompatibility , panel reactive antibody , immunology , antibody , human leukocyte antigen , isoantibodies , blood type (non human) , thymoglobulin , rituximab , kidney , antigen
Potential live kidney donors have been rejected when the prospective recipients are blood type or crossmatch incompatible. By utilizing plasmapheresis combined with intravenous immune globulin (PP/IVIg) prior to surgery, donor‐specific antibodies against blood group or human leukocyte antigens (HLA) have been removed, thereby allowing successful renal transplantation. A 26‐yr‐old male with a panel reactive antibody level of 100% and repeated positive crossmatches against deceased donor kidney offers, including zero HLA mismatched donors, successfully underwent ABO‐incompatible kidney transplantation from his HLA‐identical but nevertheless crossmatch‐incompatible sister. The initial anti‐A blood group isoagglutinin titers were 128, 256, and 1024 at room temperature, 37°C, and 37°C anti‐IgG enhanced, respectively. With an individualized PP/IVIg regimen based on donor‐specific antibody titer, however, the relevant antibodies were adequately reduced and hyperacute rejection avoided. Subsequent antibody‐mediated rejection, likely directed against a minor histocompatibility antigen, was diagnosed on postoperative day 7 and successfully treated. Neither ABO, or crossmatch incompatibility, or both in combination prohibit kidney transplantation.