Premium
ABO Incompatible Kidney Transplantations Without Splenectomy, Using Antigen‐Specific Immunoadsorption and Rituximab
Author(s) -
Tydén Gunnar,
Kumlien Gunilla,
Genberg Helena,
Sandberg John,
Lundgren Torbjörn,
Fehrman Ingela
Publication year - 2005
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.1600-6143.2004.00653.x
Subject(s) - medicine , immunoadsorption , rituximab , splenectomy , plasmapheresis , immunosuppression , transplantation , kidney transplantation , tacrolimus , abo blood group system , surgery , gastroenterology , urology , immunology , antibody , spleen
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.