In:
Xenotransplantation, Wiley, Vol. 13, No. 2 ( 2006-03), p. 141-147
Abstract:
Abstract: Background: Antigen‐specific immunoadsorption combined with rituximab offers the possibility for ABO‐incompatible kidney transplantation without splenectomy. Patient and method: An 8‐year‐old mentally retarded girl with steroid‐resistant nephrotic syndrome and focal segmental glomerulosclerosis due to mitochondriopathy poorly tolerated hemodialysis. Paternal blood group A1B was incompatible with blood group B of the child. Therefore, we decided to perform the first ABO‐incompatible renal transplantation in a child in Germany using antigen‐specific immunoadsorption. Rituximab (1 × 375 mg/m 2 ) was administered 2 weeks before the first immunoadsorption (Glycosorb ® ABO A‐column). Triple‐drug immunosuppression (tacrolimus, mycophenolate mofetil and prednisolone) was simultaneously started with immunoadsorption. Initial tacrolimus levels were targeted between 15 and 20 ng/ml. Before transplantation, six immunoadsorptions were applied on days −9, −7, −4, −3, −2 and −1. Intravenous immunoglobulin (0.5 g/kg) was administered preoperatively. After transplantation, three immunoadsorptions were performed on days +4, +6 and +8. Results: Before transplantation, antibody (Ab) titers against paternal erythrocytes (20°C) were reduced from 1 : 64 to 1 : 4 by six antigen‐specific immunoadsorptions. After transplantation, we performed three more immunoadsorptions and the Ab titers were stable between 1 : 1 and 1 : 8. One, 2 and 8 months later we observed increases in the Ab titer up to 1 : 32 requiring no change in immunosuppressive therapy. No side effects of immunoadsorption were observed. The girl had excellent initial graft function with a serum creatinine of 55 to 70 μmol/l. Two weeks after transplantation, graft biopsy showed no signs of rejection; there was focal positivity for C4d only. Twelve months after transplantation, renal function was stable, with a serum creatinine of 117 μmol/l. Episodes of rejection or severe infections were absent. Conclusion: ABO‐incompatible transplantation using antigen‐specific immunoadsorption and rituximab may serve as a suitable alternative for children urgently needing renal transplantation and missing a blood group‐compatible donor.
Type of Medium:
Online Resource
ISSN:
0908-665X
,
1399-3089
DOI:
10.1111/xen.2006.13.issue-2
DOI:
10.1111/j.1399-3089.2006.00279.x
Language:
English
Publisher:
Wiley
Publication Date:
2006
detail.hit.zdb_id:
2011995-1
