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 Peter Grande, Thomas R. Schwab, Matthew D. Griffin, Mikel Prieto, Scott Nyberg, Jorge A. Velosa, Stephen C Textor, Jeffrey L. Platt, Mark D Stegall

Research output: Contribution to journalArticle

165 Citations (Scopus)

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
StatePublished - Apr 15 2003

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Living Donors
varespladib methyl
Kidney Transplantation
Kidney
Plasmapheresis
Intravenous Immunoglobulins
Mycophenolic Acid
Antibodies
Tacrolimus
Graft Survival
Splenectomy
Blood Group Antigens
Prednisone
Transplants
Immunosuppression
Survival Rate
Feasibility Studies
Immunosuppressive Agents
Blood Donors
Glomerular Filtration Rate

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Gloor, J. M., Lager, D. J., Moore, S. B., Pineda, A. A., Fidler, M. E., Larson, T. S., ... Stegall, M. D. (2003). ABO-incompatible kidney transplantation using both A2 and non-A2 living donors. Transplantation, 75(7), 971-977.

ABO-incompatible kidney transplantation using both A2 and non-A2 living donors. / Gloor, James M.; Lager, Donna J.; Moore, S. Breanndan; Pineda, Alvaro A.; Fidler, Mary E.; Larson, Timothy S.; Grande, Joseph Peter; Schwab, Thomas R.; Griffin, Matthew D.; Prieto, Mikel; Nyberg, Scott; Velosa, Jorge A.; Textor, Stephen C; Platt, Jeffrey L.; Stegall, Mark D.

In: Transplantation, Vol. 75, No. 7, 15.04.2003, p. 971-977.

Research output: Contribution to journalArticle

Gloor, JM, Lager, DJ, Moore, SB, Pineda, AA, Fidler, ME, Larson, TS, Grande, JP, Schwab, TR, Griffin, MD, Prieto, M, Nyberg, S, Velosa, JA, Textor, SC, Platt, JL & Stegall, MD 2003, 'ABO-incompatible kidney transplantation using both A2 and non-A2 living donors', Transplantation, vol. 75, no. 7, pp. 971-977.
Gloor JM, Lager DJ, Moore SB, Pineda AA, Fidler ME, Larson TS et al. ABO-incompatible kidney transplantation using both A2 and non-A2 living donors. Transplantation. 2003 Apr 15;75(7):971-977.
Gloor, James M. ; Lager, Donna J. ; Moore, S. Breanndan ; Pineda, Alvaro A. ; Fidler, Mary E. ; Larson, Timothy S. ; Grande, Joseph Peter ; Schwab, Thomas R. ; Griffin, Matthew D. ; Prieto, Mikel ; Nyberg, Scott ; Velosa, Jorge A. ; Textor, Stephen C ; Platt, Jeffrey L. ; Stegall, Mark D. / ABO-incompatible kidney transplantation using both A2 and non-A2 living donors. In: Transplantation. 2003 ; Vol. 75, No. 7. pp. 971-977.
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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.",
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T1 - ABO-incompatible kidney transplantation using both A2 and non-A2 living donors

AU - Gloor, James M.

AU - Lager, Donna J.

AU - Moore, S. Breanndan

AU - Pineda, Alvaro A.

AU - Fidler, Mary E.

AU - Larson, Timothy S.

AU - Grande, Joseph Peter

AU - Schwab, Thomas R.

AU - Griffin, Matthew D.

AU - Prieto, Mikel

AU - Nyberg, Scott

AU - Velosa, Jorge A.

AU - Textor, Stephen C

AU - Platt, Jeffrey L.

AU - Stegall, Mark D

PY - 2003/4/15

Y1 - 2003/4/15

N2 - 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.

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