Is Pretransplant Anti-A/B Antibody Removal Prerequisite for Successful ABO Incompatible Kidney Transplantation in Children?

S. Shishido,¹ T. Kawamura,¹ Y. Hamasaki,² Y. Takahashi,¹ Y. Hyodo,¹ Y. Itabashi,¹ H. Nihei,¹ T. Yonekura,¹ Y. Inaba,² Y. Yoshida,² K. Sakai,¹ A. Aikawa.¹

¹Nephrology, Toho University, School of Medicine, Tokyo, Japan
²Pediatric Nephrology, Too University, School of Medicine, Tokyo, Japan.

Meeting: 2015 American Transplant Congress

Abstract number: 125

Keywords: Antibodies, Kidney transplantation, Pediatric, Plasmapheresis

Session Information

Session Name: Concurrent Session: Pediatric Kidney Transplantation

Session Type: Concurrent Session

Date: Sunday, May 3, 2015

Session Time: 4:00pm-5:30pm

Presentation Time: 4:00pm-4:12pm

Location: Room 119-A

Purpose: We have recently demonstrated that the long-term outcome of ABO incompatible living donor kidney transplantation (ABOiKT) in children was comparable to those of ABO compatible KT (Transplant Proc 2012, 44, 214). Since 2009, rituximab (RIT) was given to suppress anti-donor blood group antibody instead of splenectomy. Furthermore, pretransplant plasmapheresis (PP) has been avoided since July 2013 if pretransplant anti-donor blood group antibody titer was less than x64.

The aim of this study was to evaluate the efficacy and safety of this new protocol for ABOiKT in children.

Methods: Fourteen pediatric patients have undergone ABOiKT between January 2011 and October 2014. The mean age at KT was 11.2±4.7, with 9 boys and 5 girls. The ABO blood group incompatible matches included 5 A1 to O, 3 B to O, 1 A1B to A1, 4 A1B to B, 1 A1 to B.

Calcineurin inhibitor and MMF was started 10 days before ABOiKT. RIT (100mg/body) was administrated twice on day -10 and 1 day before transplantation. Basilliximab was also given twice on day 0 and day 4. Until 2013 patients received 2-3 sessions of PP to remove the anti-A/B antibodies before ABOiKT irrespective of their antibody titer. Since July 2013, however, 7 recipients whose anti-A/B IgG titer was less than x64 underwent kidney transplantation without pretransplant PP. No patient underwent splenectomy. PP and intravenous immunoglobulin (IVIG) were not performed post-transplantation.

Results: No patient had T cell mediated nor antibody mediated acute rejection (AR) episode. Two patients showed subclinical acute rejection (borderline in 1 and AR 1a in 1) in the surveillance biopsy performed at 3 months posttransplant.

Six recipients developed a cytomegalovirus (CMV) viremia diagnosed by antigenemia. Hemorrhagic cystitis due to adenovirus infection occurred in one recipient and was cured by MMF withdrawal. Rituximab-associated late onset neutropenia was observed in 3 patients (grade 2 in 1 and grade 4 in 2). Graft and patient survival was 100% to date.

Conclusion: Our current desensitization protocol using low dose RIT without splenectomy was effective for successful ABOiKT in children. Moreover, pretransplant antibody removal might not be mandatory for recipients with low anti-A/B IgG titer.

To cite this abstract in AMA style:

Shishido S, Kawamura T, Hamasaki Y, Takahashi Y, Hyodo Y, Itabashi Y, Nihei H, Yonekura T, Inaba Y, Yoshida Y, Sakai K, Aikawa A. Is Pretransplant Anti-A/B Antibody Removal Prerequisite for Successful ABO Incompatible Kidney Transplantation in Children? [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/is-pretransplant-anti-ab-antibody-removal-prerequisite-for-successful-abo-incompatible-kidney-transplantation-in-children/. Accessed July 4, 2025.

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