Background. Plasmapheresis for antibody removal and rituximab for antibody production suppression are performed for desensitization against ABO-incompatible kidney transplantation. We evaluated clinical outcome for optimizing ABO-incompatible kidney transplantation protocol after stratified desensitization.

Methods. A total of 20 ABO-incompatible kidney transplant recipients were grouped by anti-A/B IgM and IgG antibody titers 1 month before transplantation: high-titer (≥ [times]128, n = 9, plasmapheresis four times, rituximab 100 mg twice), low-titer ([times]32 and [times]64, n = 6, plasmapheresis twice, rituximab 100 mg once), and very low-titer (≤ [times]16, n = 5, rituximab 100 mg once) groups. Anti-A/B titers, peripheral blood CD19⁺ cells, renal function, and complications 1 year post-transplantation were compared between them.

Results. All renal grafts functioned well, with no acute rejection for 1 year. Low anti-A/B IgM ([times]8, [times]2, and [times]1) and IgG ([times]4, [times]4, and [times]2) titers and low peripheral blood CD19⁺ cell counts (0.5%, 0.7%, and 0.4%) were maintained at 1 year post-transplantation in the high-, low-, and very low-titer groups, respectively. Serum creatinine (1.12 ± 0.25, 1.33 ± 0.37, and 1.18 ± 0.39 mg/dL; P = 0.68), estimated glomerular filtration rate (48.7 ± 5.6, 46.7 ± 3.2, and 49.3 ± 12.5 mL/min/1.73 m²; P = 0.90), cytomegalovirus antigenemia-positive rate (67%, 17%, and 60%; P = 0.17), and erythropoietin-stimulating agent (33%, 0%, and 20%; P = 0.75) and granulocyte colony-stimulating factor (33%, 50%, and 40%; P = 0.80) administration rates for the high-, low-, and very low-titer groups, respectively, showed no significant difference.

Conclusions. Outcome of ABO-incompatible kidney transplantation after stratified desensitization demonstrated excellent graft survival and equal complaint incidence regardless of pre-transplantation anti-A/B antibody titers.

CITATION INFORMATION: Nanmoku K, Kurosawa A, Kubo T, Shinzato T, Shimizu T, Kimura T, Yagisawa T. Outcome of ABO-Incompatible Kidney Transplantation After Stratified Desensitization. Am J Transplant. 2017;17 (suppl 3).

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