ABO-incompatible kidney transplantation of an 8-yr-old girl with donor/recipient-constellation A1B/B

Xenotransplantation
Thurid AhlenstielJürgen Klempnauer

Abstract

Antigen-specific immunoadsorption combined with rituximab offers the possibility for ABO-incompatible kidney transplantation without splenectomy. An 8-year-old mentally retarded girl with steroid-resistant nephrotic syndrome and focal segmental glomerulosclerosis due to mitochondriopathy poorly tolerated hemodialysis. Paternal blood group A1B was incompatible with blood group B of the child. Therefore, we decided to perform the first ABO-incompatible renal transplantation in a child in Germany using antigen-specific immunoadsorption. Rituximab (1 x 375 mg/m2) was administered 2 weeks before the first immunoadsorption (Glycosorb) ABO A-column). Triple-drug immunosuppression (tacrolimus, mycophenolate mofetil and prednisolone) was simultaneously started with immunoadsorption. Initial tacrolimus levels were targeted between 15 and 20 ng/ml. Before transplantation, six immunoadsorptions were applied on days -9, -7, -4, -3, -2 and -1. Intravenous immunoglobulin (0.5 g/kg) was administered preoperatively. After transplantation, three immunoadsorptions were performed on days +4, +6 and +8. Before transplantation, antibody (Ab) titers against paternal erythrocytes (20 degrees C) were reduced from 1 : 64 to 1 : 4 by six antigen-specific...Continue Reading

References

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Citations

May 15, 2008·Langenbeck's Archives of Surgery·Michael NeippJürgen Klempnauer
Sep 11, 2012·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Betti SchaeferClaus Peter Schmitt
May 31, 2011·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Antje HabichtAnke Schwarz
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May 22, 2018·Transplantation·Motoshi HattoriUNKNOWN Japan Society for Transplantation and Japanese Society for Clinical Renal Transplantation
Jul 18, 2021·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Jelena StojanovicStephen D Marks

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