Back to Search
Start Over
ABO-incompatible pediatric kidney transplantation without antibody removal.
- Source :
-
Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2020 Jan; Vol. 35 (1), pp. 95-102. Date of Electronic Publication: 2019 Oct 31. - Publication Year :
- 2020
-
Abstract
- Background: Because of the severe shortage of suitable deceased donors, ABO-incompatible living donor kidney transplantation (ABOi LDKT) is performed even in pediatric recipients in Japan. We performed pediatric ABOi LDKT using rituximab without anti-A/B antibody removal.<br />Methods: Thirteen pediatric recipients (mean age 7.4, range 3.4-15.7, four females) whose baseline anti-A/B IgG titers were ≤ × 64 underwent ABOi LDKT without antibody removal and splenectomy between July 2013 and April 2017 at Toho University. Mycophenolate mofetil (MMF) was initiated on day - 10. Rituximab (100 mg) was administered twice. Basiliximab and triple maintenance immunosuppression (calcineurin inhibitor, MMF, and steroids) were administered. Protocol biopsy was performed at 3 months and 1 year after transplantation. We retrospectively compared the clinical outcomes between these recipients and 37 children (mean age 9.0, range 2.6-18.9, 15 female) who underwent ABO-compatible (ABOc) LDKT during the same period.<br />Results: The mean follow-up periods of ABOi and ABOc groups were 31.9 ± 13.5 and 28.8 ± 14.4 months, respectively. In the ABOi group, no clinical acute rejection (AR) was noted and subclinical AR was observed in four patients without evidence of acute antibody-mediated rejection. In the ABOc group, clinical and subclinical AR developed in 3 and 10 patients, respectively. No significant difference was identified for the mean eGFR between the ABOi and ABOc groups (98.3 ± 48.8 vs. 86.9 ± 39.4, P = 0.452 at 3 months; 78.2 ± 21.2 vs. 79.7 ± 21.3, at 1 year, P = 0.830). Death-censored graft survival at follow-up was 100% in the ABOi group and 94.6% in the ABOc group. Patient survival during the follow-up period in both the groups was 100%. Late-onset neutropenia (LON) requiring granulocyte colony-stimulating factor occurred more frequently in the ABOi group than in the ABOc group (4 vs. 0 patients) (P < 0.001).<br />Conclusions: Pre- and post-transplantation antibody removal is not a prerequisite for successful pediatric ABOi LDKT, at least in patients with a low anti-A/B IgG antibody titer. However, LON caused by rituximab should be monitored.
- Subjects :
- Adolescent
Allografts immunology
Allografts pathology
Allografts supply & distribution
Antibodies immunology
Antibodies isolation & purification
Biopsy
Blood Group Incompatibility blood
Child
Child, Preschool
Drug Administration Schedule
Drug Therapy, Combination methods
Female
Follow-Up Studies
Graft Rejection blood
Graft Rejection epidemiology
Graft Rejection pathology
Graft Survival drug effects
Graft Survival immunology
Humans
Immunosuppression Therapy methods
Japan
Kidney immunology
Kidney pathology
Kidney Failure, Chronic blood
Kidney Failure, Chronic mortality
Kidney Transplantation methods
Living Donors
Male
Plasmapheresis
Retrospective Studies
Treatment Outcome
ABO Blood-Group System immunology
Blood Group Incompatibility therapy
Graft Rejection prevention & control
Immunosuppressive Agents administration & dosage
Kidney Failure, Chronic surgery
Kidney Transplantation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1432-198X
- Volume :
- 35
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Pediatric nephrology (Berlin, Germany)
- Publication Type :
- Academic Journal
- Accession number :
- 31673829
- Full Text :
- https://doi.org/10.1007/s00467-019-04376-7