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Plasmapheresis, CMV Hyperimmune Globulin, and Anti‐CD20 Allow ABO‐Incompatible Renal Transplantation Without Splenectomy
Author(s) -
Sonnenday Christopher J.,
Warren Daniel S.,
Cooper Mathew,
Samaniego Milagros,
Haas Mark,
King Karen E.,
Shirey R. Sue,
Simpkins Christopher E.,
Montgomery Robert A.
Publication year - 2004
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2004.00507.x
Subject(s) - medicine , plasmapheresis , splenectomy , rituximab , transplantation , abo blood group system , kidney transplantation , surgery , urology , gastroenterology , immunology , antibody , spleen
The majority of preconditioning protocols developed to allow ABO‐incompatible (ABOi) renal transplantation include concurrent splenectomy as a prerequisite to successful engraftment. Our center has developed a preconditioning protocol that includes plasmapheresis (PP), low‐dose CMV hyperimmune globulin (CMVIg), and anti‐CD20 monoclonal antibody (rituximab) to allow ABOi renal transplantation without splenectomy. Our initial experience has included treatment of six recipients and successful transplantation from blood group A 1 , A 2 , and group B living donors. Mean (± SD) serum creatinine was 1.3 ± 0.1 mg/dL among the six recipients and no episodes of antibody‐mediated rejection (AMR) occurred at a median follow‐up of 12 months. ABO antibody titers have remained below pretreatment levels. The absence of AMR and stable allograft function in this series show the potential of this preconditioning protocol to increase ABOi renal transplantation. The use of rituximab, allowing avoidance of splenectomy, may further remove one of the significant disincentives to ABOi transplantation, and eliminate the risk of post‐splenectomy infections.