ABO-incompatible kidney transplantation using both A2 and non-A2 living donors

James M. Gloor, Donna J. Lager, S. Breanndan Moore, Alvaro A. Pineda, Mary E. Fidler, Timothy S. Larson, Joseph P. Grande, Thomas R. Schwab, Matthew D. Griffin, Mikel Prieto, Scott L. Nyberg, Jorge A. Velosa, Steven C. Textor, Jeffrey L. Platt, Mark D. Stegall

Research output: Contribution to journalArticle

166 Scopus citations

Abstract

Background. Given the scarcity of cadaveric organs, efforts are intensifying to increase the availability of living donors. The current study assessed the feasibility of using ABO-incompatible living-donor kidneys to expand the donor pool. Methods. The authors performed 18 ABO-incompatible living-donor kidney transplants between May 1999 and April 2001. Ten patients received living-donor kidneys from A2 and eight patients received kidneys from non-A2 blood group donors. Immunosuppression consisted of Thymoglobulin antibody induotion, tacrolimus, mycophenolate mofetil, and prednisone. Eight non-A2 and two A2 kidney recipients also received a pretransplant conditioning regimen of four plasmapheresis treatments followed by intravenous immunoglobulin and splenectomy at the time of transplantation. Antidonor blood group antibody titer was measured at baseline, pretransplant, at 1- to 3-month and 1-year follow-up, and at the time of diagnosis of antibody-mediated rejection. Results. No hyperacute rejection episodes occurred. One-year graft and patient survival rates in the 18 ABO-incompatible recipients were only slightly lower than those of 81 patients who received ABO-compatible kidney transplants during the same period (89% vs. 96% and 94% vs. 99%, respectively). Glomerular filtration rate and serum creatinine levels did not differ between the groups. Antibody-mediated rejection occurred in 28% of ABO-incompatible recipients, and was reversible with plasmapheresis, intravenous immunoglobulin, and increasing immunosuppression in all patients except one. Conclusions. ABO-incompatible living donor kidney transplants can achieve an acceptable 1-year graft survival rate using an immunosuppressive regimen consisting of Thymoglobulin induction, tacrolimus, mycophenolate mofetil, and prednisone combined with pretransplant plasmapheresis, intravenous immunoglobulin, and splenectomy.

Original languageEnglish (US)
Pages (from-to)971-977
Number of pages7
JournalTransplantation
Volume75
Issue number7
DOIs
StatePublished - Apr 15 2003

ASJC Scopus subject areas

  • Transplantation

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    Gloor, J. M., Lager, D. J., Moore, S. B., Pineda, A. A., Fidler, M. E., Larson, T. S., Grande, J. P., Schwab, T. R., Griffin, M. D., Prieto, M., Nyberg, S. L., Velosa, J. A., Textor, S. C., Platt, J. L., & Stegall, M. D. (2003). ABO-incompatible kidney transplantation using both A2 and non-A2 living donors. Transplantation, 75(7), 971-977. https://doi.org/10.1097/01.TP.0000058226.39732.32