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AB0 incompatible kidney transplantation – first experiences


Authors: Ondřej Viklický 1;  Alena Paříková 1;  Janka Slatinská 1;  Vladimír Hanzal 1;  Libuše Pagáčová 2;  Eva Honsová 3;  Eva Kieslichová 4;  Libor Janoušek 5;  Jiří Froněk 5
Authors place of work: Klinika nefrologie IKEM Praha, přednosta prof. MUDr. Ondřej Viklický, CSc. 1;  Pracoviště laboratorních metod IKEM Praha, přednosta prof. MUDr. Antonín Jabor, CSc. 2;  Pracoviště klinické a transplantační patologie IKEM Praha, přednostka doc. MUDr. Eva Honsová, Ph. D. 3;  Klinika anestezie, resuscitace a intenzivní péče IKEM Praha, přednostka MUDr. Eva Kieslichová, Ph. D. 4;  Klinika transplantační chirurgie IKEM Praha, přednosta doc. MUDr. Jiří Froněk, Ph. D., FRCS 5
Published in the journal: Vnitř Lék 2015; 61(7-8): 725-730
Category: Vanýsek´s day 2015

Summary

Living donor AB0 incompatible kidney transplantation represents a new tool how to improve the access to transplantation. Majority of European protocols are based on desensitization with rituximab, triple drug immunosuppression, intravenous immunoglobulins and specific immunoadsoption (IA) which eliminates isohaemaglutinins. AB0i kidney transplant program was initiated in our centre in 2011 and 21 patients have received grafts from incompatible donors until recently. Highest accepted isohaemaglutinins titers before rituximab were 1 : 64 and corresponding pretransplant immunoadsorption procedures varied from 2 to 9. In 5 patients 1–2 IA procedures were performed also after transplantation. With the advent of paired exchange program the AB0i transplantation is offered to patients with unsuccessful matching run or with aim to improve HLA match between donor and recipient. The main complications were postoperative bleeding and urinary tract infections in patients at risk. Majority of protocol biopsies exhibited positivity of C4d staining. Neither graft loss nor patient death were noticed.

Key words:
AB0 incompatibility – glycosorb – immunoadsorption – kidney transplantation


Zdroje

1. Maggiore U, Oberbauer R, Pascual J et al. ERA-EDTA-DESCARTES Working Group. Strategies to increase the donor pool and access to kidney transplantation: an international perspective. Nephrol Dial Transplant 2015; 30(2): 217–222.

2. Tydén G, Kumlien G, Genberg H et al. AB0 incompatible kidney transplantations without splenectomy, using antigen-specific immunoadsorption and rituximab. Am J Transplant 2005; 5(1): 145–148.

3. Agishi T, Takahashi K, Yagisawa T et al. Immunoadsorption of anti-A or anti-B antibody for successful kidney transplantation between ABO incompatible pairs and its limitation. Japanese Biosynsorb Research Group. ASAIO Trans 1991; 37(3): M496-M498.

4. Tanabe K, Takahashi K, Sonda K et al. Long-term results of ABO-incompatible living kidney transplantation: a single-center experience. Transplantation 1998; 65(2): 224–228.

5. Sonnenday CJ, Warren DS, Cooper M et al. Plasmapheresis, CMV hyperimmune globulin, and anti-CD20 allow ABO-incompatible renal transplantation without splenectomy. Am J Transplant 2004; 4(8): 1315–1322.

6. Segev DL, Simpkins CE, Warren DS et al. AB0 incompatible high-titer renal transplantation without splenectomy or anti-CD20 treatment. Am J Transplant 2005; 5(10): 2570–2575.

7. Genberg H, Kumlien G, Wennberg L et al. AB0-incompatible kidney transplantation using antigen-specific immunoadsorption and rituximab: a 3-year follow-up. Transplantation 2008; 85(12): 1745–1754.

8. Hickstein H, Koball S, Lehmann R et al. AB0 incompatible kidney transplantation using unspecific immunoadsorption. Transfus Apher Sci 2014; 50(2): 263–266.

9. Wilpert J, Geyer M, Teschner S et al. AB0-incompatible kidney transplantation-proposal of an intensified apheresis strategy for patients with high initial isoagglutinine titers. J Clin Apher 2007; 22(6): 314–322.

10. Haidinger M, Schmaldienst S, Körmöczi G et al. Vienna experience of ABO-incompatible living-donor kidney transplantation. Wien Klin Wochenschr 2009; 121(7–8): 247–255.

11. Kim MH, Jun KW, Hwang JK et al. Risk factors for postoperative bleeding in AB0-incompatible kidney transplantation. Clin Transplant 2015; 29(4): 365–372.

12. Lentine KL, Axelrod D, Klein C et al. Early clinical complications after AB0-incompatible live-donor kidney transplantation: a national study of Medicare-insured recipients. Transplantation 2014; 98(1): 54–65.

13. de Weerd AE, van Agteren M, Leebeek FW et al. AB0-incompatible kidney transplant recipients have a higher bleeding risk after antigen-specific immunoadsorption. Transpl Int 2015; 28(1): 25–33.

14. Renner FC, Czekalinska B, Kemkes-Matthes B et al. Postoperative bleeding after AB0-incompatible living donor kidney transplantation. Transplant Proc 2010; 42(10): 4164–4166.

15. Schachtner T, Stein M, Reinke P. AB0 desensitization affects cellular immunity and infection control after renal transplantation. Transpl Int 2015. Dostupné z DOI: <http://dx.doi.org/10.1111/tri.12616>.

16. Esezobor CI, Nourse P, Gajjar P. Urinary tract infection following kidney transplantation: frequency, risk factors and graft function. Pediatr Nephrol 2012; 27(4): 651–657.

17. Fehr T, Stussi G. AB0-incompatible kidney transplantation. Curr Opin Organ Transplant 2012; 17(4): 376–385.

18. Couzi L, Perera R, Manook M et al. Incidence and Outcome of C4d Staining With Tubulointerstitial Inflammation in Blood Group-incompatible Kidney Transplantation. Transplantation 2015; 99(7): 1487–1494.

19. Macklin PS, Morris PJ, Knight SR. A systematic review of the use of rituximab as induction therapy in renal transplantation. Transplant Rev (Orlando) 2015; 29(2): 103–108.

20. Viklicky O, Krystufkova E, Brabcova I et al. B-cell-related biomarkers of tolerance are up-regulated in rejection-free kidney transplant recipients. Transplantation 2013; 95(1): 148–154.

21. Ferrari P, Hughes PD, Cohney SJ et al. AB0-incompatible matching significantly enhances transplant rates in kidney paired donation. Transplantation 2013; 96(9): 821–826.

22. Genberg H, Kumlien G, Wennberg L et al. Isoagglutinin adsorption in AB0-incompatible transplantation. Transfus Apher Sci 2010; 43(2): 231–235.

23. Opelz G, Morath C, Süsal C et al. Three-year outcomes following 1420 AB0-incompatible living-donor kidney transplants performed after ABO antibody reduction: results from 101 centers. Transplantation 2015; 99(2): 400–404.

Štítky
Diabetology Endocrinology Internal medicine

Článok vyšiel v časopise

Internal Medicine

Číslo 7-8

2015 Číslo 7-8
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