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Outcome of ABO-incompatible kidney transplantation using a modified desensitization protocol without plasmapheresis.
- Source :
-
International journal of urology : official journal of the Japanese Urological Association [Int J Urol] 2022 Sep; Vol. 29 (9), pp. 1017-1025. Date of Electronic Publication: 2022 Jun 06. - Publication Year :
- 2022
-
Abstract
- Objectives: Several controversies regarding desensitization strategies for successful ABO-incompatible (ABOi) kidney transplantation still exist. This study aimed to investigate whether pretransplant anti-A/B antibody removal is mandatory in an ABOi kidney transplant recipient with low baseline isoagglutinin titers.<br />Methods: We adopted a modified desensitization protocol with two doses of rituximab (RTX, 100 mg/body) without pretransplant antibody removal for ABOi kidney transplant recipients with a titer of ≤1:64 (group A; n = 35) and investigated the feasibility of this protocol by comparing it with the clinical outcomes of patients undergoing standard pretransplant plasmapheresis (group B; n = 21).<br />Results: There was no significant difference in the rate of antibody-mediated rejection within the first month after transplantation between the two groups (11.4% in group A vs. 2% in group B, p = 0.6019). Moreover, no differences were observed in the short- and long-term graft outcomes between the groups. However, two major critical acute antibody-mediated events occurred in group A; one patient lost the graft due to hyperacute rejection, and the other patient developed thrombotic microangiopathy after surgery. Risk factors predicting these perioperative complications were not identified.<br />Conclusions: We conclude that not only B-cell depletion using RTX but also pretransplant antibody removal is still recommended even for patients with low isoagglutinin titers. In addition, a new diagnostic tool is needed for accurate risk stratification.<br /> (© 2022 The Japanese Urological Association.)
- Subjects :
- ABO Blood-Group System
Blood Group Incompatibility
Graft Rejection prevention & control
Graft Survival
Humans
Plasmapheresis adverse effects
Plasmapheresis methods
Rituximab therapeutic use
Treatment Outcome
Kidney Transplantation adverse effects
Kidney Transplantation methods
Transfusion Reaction etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1442-2042
- Volume :
- 29
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- International journal of urology : official journal of the Japanese Urological Association
- Publication Type :
- Academic Journal
- Accession number :
- 35661428
- Full Text :
- https://doi.org/10.1111/iju.14944