Plasma exchange conditioning for ABO-incompatible renal transplantation

Jeffrey L. Winters, J. M. Gloor, A. A. Pineda, Mark D Stegall, S. B. Moore

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

The supply of deceased donor kidneys is inadequate to meet demand. To expand the pool of potential donors, ABO-incompatible transplants from living donors have been performed. We present the Mayo Clinic experience with such transplants. Enrollment was open to patients when the only available potential living kidney donor was ABO-incompatible. Conditioning consisted of plasma exchanges followed by intravenous immunoglobulin. Splenectomy was performed at the time of transplant surgery. Post-transplant immunosuppression consisted of anti-T lymphocyte antibody, tacrolimus, mycophenolate mofetil, and prednisone. Isoagglutinin titers and scores were determined before and after each plasma exchange. Transplant outcomes were determined. Twenty-six ABO-incompatible transplants were performed. No hyperacute rejection occurred. Mean patient follow-up was 400 days. Patient and graft survivals at last follow-up were 92 and 85%, respectively. Antibody-mediated rejection occurred in 46% and was apparently reversed in 83% by plasma exchange and increased immunosuppression. The initial plasma exchange reduced immediate spin and AHG hemagglutination reactivity scores by 53.5 and 34.6%, respectively. Over the course of the pretransplant plasma exchanges, the immediate spin and AHG hemagglutination reactivity scores decreased by 96.4 and 68.5%, respectively. At 3 and 12 months, the immediate spin and AHG hemagglutinin reactivity scores and titers were less than those at baseline but greater than or equal to those on the day of transplantation. Despite an increase in scores and titers, antibody-mediated rejection was not present. Pre-transplant plasma exchange conditioning combined with other immunosuppressives can be used to prepare patients for ABO-incompatible kidney transplantation from living donors, but antibody-mediated rejection post-transplant is a common occurrence and allograft survival may be reduced. Controlled clinical trials are needed to identify the optimum conditioning for ABO-incompatible renal transplants.

Original languageEnglish (US)
Pages (from-to)79-85
Number of pages7
JournalJournal of Clinical Apheresis
Volume19
Issue number2
DOIs
StatePublished - 2004

Fingerprint

Plasma Exchange
Kidney Transplantation
Transplants
Living Donors
Antibodies
Hemagglutination
Kidney
Immunosuppression
Tissue Donors
Mycophenolic Acid
Intravenous Immunoglobulins
Controlled Clinical Trials
Graft Rejection
Hemagglutinins
Tacrolimus
Graft Survival
Splenectomy
Immunosuppressive Agents
Prednisone
Allografts

Keywords

  • ABO score
  • ABO titer
  • Antibody-mediated rejection
  • Hyperacute rejection

ASJC Scopus subject areas

  • Hematology

Cite this

Plasma exchange conditioning for ABO-incompatible renal transplantation. / Winters, Jeffrey L.; Gloor, J. M.; Pineda, A. A.; Stegall, Mark D; Moore, S. B.

In: Journal of Clinical Apheresis, Vol. 19, No. 2, 2004, p. 79-85.

Research output: Contribution to journalArticle

Winters, Jeffrey L. ; Gloor, J. M. ; Pineda, A. A. ; Stegall, Mark D ; Moore, S. B. / Plasma exchange conditioning for ABO-incompatible renal transplantation. In: Journal of Clinical Apheresis. 2004 ; Vol. 19, No. 2. pp. 79-85.
@article{180a0979ae4d44b59f02ca01ea55eec0,
title = "Plasma exchange conditioning for ABO-incompatible renal transplantation",
abstract = "The supply of deceased donor kidneys is inadequate to meet demand. To expand the pool of potential donors, ABO-incompatible transplants from living donors have been performed. We present the Mayo Clinic experience with such transplants. Enrollment was open to patients when the only available potential living kidney donor was ABO-incompatible. Conditioning consisted of plasma exchanges followed by intravenous immunoglobulin. Splenectomy was performed at the time of transplant surgery. Post-transplant immunosuppression consisted of anti-T lymphocyte antibody, tacrolimus, mycophenolate mofetil, and prednisone. Isoagglutinin titers and scores were determined before and after each plasma exchange. Transplant outcomes were determined. Twenty-six ABO-incompatible transplants were performed. No hyperacute rejection occurred. Mean patient follow-up was 400 days. Patient and graft survivals at last follow-up were 92 and 85{\%}, respectively. Antibody-mediated rejection occurred in 46{\%} and was apparently reversed in 83{\%} by plasma exchange and increased immunosuppression. The initial plasma exchange reduced immediate spin and AHG hemagglutination reactivity scores by 53.5 and 34.6{\%}, respectively. Over the course of the pretransplant plasma exchanges, the immediate spin and AHG hemagglutination reactivity scores decreased by 96.4 and 68.5{\%}, respectively. At 3 and 12 months, the immediate spin and AHG hemagglutinin reactivity scores and titers were less than those at baseline but greater than or equal to those on the day of transplantation. Despite an increase in scores and titers, antibody-mediated rejection was not present. Pre-transplant plasma exchange conditioning combined with other immunosuppressives can be used to prepare patients for ABO-incompatible kidney transplantation from living donors, but antibody-mediated rejection post-transplant is a common occurrence and allograft survival may be reduced. Controlled clinical trials are needed to identify the optimum conditioning for ABO-incompatible renal transplants.",
keywords = "ABO score, ABO titer, Antibody-mediated rejection, Hyperacute rejection",
author = "Winters, {Jeffrey L.} and Gloor, {J. M.} and Pineda, {A. A.} and Stegall, {Mark D} and Moore, {S. B.}",
year = "2004",
doi = "10.1002/jca.20002",
language = "English (US)",
volume = "19",
pages = "79--85",
journal = "Journal of Clinical Apheresis",
issn = "0733-2459",
publisher = "Wiley-Liss Inc.",
number = "2",

}

TY - JOUR

T1 - Plasma exchange conditioning for ABO-incompatible renal transplantation

AU - Winters, Jeffrey L.

AU - Gloor, J. M.

AU - Pineda, A. A.

AU - Stegall, Mark D

AU - Moore, S. B.

PY - 2004

Y1 - 2004

N2 - The supply of deceased donor kidneys is inadequate to meet demand. To expand the pool of potential donors, ABO-incompatible transplants from living donors have been performed. We present the Mayo Clinic experience with such transplants. Enrollment was open to patients when the only available potential living kidney donor was ABO-incompatible. Conditioning consisted of plasma exchanges followed by intravenous immunoglobulin. Splenectomy was performed at the time of transplant surgery. Post-transplant immunosuppression consisted of anti-T lymphocyte antibody, tacrolimus, mycophenolate mofetil, and prednisone. Isoagglutinin titers and scores were determined before and after each plasma exchange. Transplant outcomes were determined. Twenty-six ABO-incompatible transplants were performed. No hyperacute rejection occurred. Mean patient follow-up was 400 days. Patient and graft survivals at last follow-up were 92 and 85%, respectively. Antibody-mediated rejection occurred in 46% and was apparently reversed in 83% by plasma exchange and increased immunosuppression. The initial plasma exchange reduced immediate spin and AHG hemagglutination reactivity scores by 53.5 and 34.6%, respectively. Over the course of the pretransplant plasma exchanges, the immediate spin and AHG hemagglutination reactivity scores decreased by 96.4 and 68.5%, respectively. At 3 and 12 months, the immediate spin and AHG hemagglutinin reactivity scores and titers were less than those at baseline but greater than or equal to those on the day of transplantation. Despite an increase in scores and titers, antibody-mediated rejection was not present. Pre-transplant plasma exchange conditioning combined with other immunosuppressives can be used to prepare patients for ABO-incompatible kidney transplantation from living donors, but antibody-mediated rejection post-transplant is a common occurrence and allograft survival may be reduced. Controlled clinical trials are needed to identify the optimum conditioning for ABO-incompatible renal transplants.

AB - The supply of deceased donor kidneys is inadequate to meet demand. To expand the pool of potential donors, ABO-incompatible transplants from living donors have been performed. We present the Mayo Clinic experience with such transplants. Enrollment was open to patients when the only available potential living kidney donor was ABO-incompatible. Conditioning consisted of plasma exchanges followed by intravenous immunoglobulin. Splenectomy was performed at the time of transplant surgery. Post-transplant immunosuppression consisted of anti-T lymphocyte antibody, tacrolimus, mycophenolate mofetil, and prednisone. Isoagglutinin titers and scores were determined before and after each plasma exchange. Transplant outcomes were determined. Twenty-six ABO-incompatible transplants were performed. No hyperacute rejection occurred. Mean patient follow-up was 400 days. Patient and graft survivals at last follow-up were 92 and 85%, respectively. Antibody-mediated rejection occurred in 46% and was apparently reversed in 83% by plasma exchange and increased immunosuppression. The initial plasma exchange reduced immediate spin and AHG hemagglutination reactivity scores by 53.5 and 34.6%, respectively. Over the course of the pretransplant plasma exchanges, the immediate spin and AHG hemagglutination reactivity scores decreased by 96.4 and 68.5%, respectively. At 3 and 12 months, the immediate spin and AHG hemagglutinin reactivity scores and titers were less than those at baseline but greater than or equal to those on the day of transplantation. Despite an increase in scores and titers, antibody-mediated rejection was not present. Pre-transplant plasma exchange conditioning combined with other immunosuppressives can be used to prepare patients for ABO-incompatible kidney transplantation from living donors, but antibody-mediated rejection post-transplant is a common occurrence and allograft survival may be reduced. Controlled clinical trials are needed to identify the optimum conditioning for ABO-incompatible renal transplants.

KW - ABO score

KW - ABO titer

KW - Antibody-mediated rejection

KW - Hyperacute rejection

UR - http://www.scopus.com/inward/record.url?scp=3442883348&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=3442883348&partnerID=8YFLogxK

U2 - 10.1002/jca.20002

DO - 10.1002/jca.20002

M3 - Article

VL - 19

SP - 79

EP - 85

JO - Journal of Clinical Apheresis

JF - Journal of Clinical Apheresis

SN - 0733-2459

IS - 2

ER -