Pinpoint targeted immunosuppression: anti-CD20/MMF desensitization with anti-CD25 in successful ABO-incompatible kidney transplantation without splenectomy

Xenotransplantation
Kazuhide SaitoK Takahashi

Abstract

In Japan, ABO-incompatible (ABO-I) kidney transplantation began in 1989; these transplantations have flourished because of the lack of cadaveric donors, and more than 600 cases were performed up to 2004. Splenectomy has been considered to be necessary for successful ABO-I kidney transplantation, and the majority of pre-conditioning protocols include splenectomy in Japan. However, we have lost some grafts due to antibody-mediated rejection (AMR) accompanying explosive elevation of anti-A/B antibody (Ab) titer even though the patients had a low pre-operative Ab titer. We utilized two doses of anti-CD20, rituximab, simply combined with mycophenolate mofetil (MMF)/low-dose steroid desensitization started 1 month before surgery in ABO-I kidney transplantation. Two sessions of pre-operative Ab removal by double filtration plasmapheresis or plasma exchange were carried out. We performed six ABO-I kidney transplantations without splenectomy. Anti-A/B Ab titers were more than 16 to 32 times before treatment. We did not plan any post-operative repeated Ab removal or intravenous immunoglobulin G (IVIG). Pre-operative anti-A/B Ab titers were successfully reduced to less than eight times in all cases. Except for one case in which we had to ...Continue Reading

References

Jan 1, 1996·Transplant International : Official Journal of the European Society for Organ Transplantation·I KoyamaR Omoto
Jun 9, 1999·Transplantation·A M AlkhunaiziD J Norman
Jun 16, 2004·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Kota TakahashiUNKNOWN Japanese ABO-Incompatible Kidney Transplantation Committee
Jul 23, 2004·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Christopher J SonnendayRobert A Montgomery
Jun 16, 2005·Clinical Transplantation·Kota Takahashi

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Citations

Oct 23, 2008·Nature Clinical Practice. Nephrology·Naotsugu Ichimaru, Shiro Takahara
Dec 20, 2007·Current Opinion in Nephrology and Hypertension·James M Gloor, Mark D Stegall
Feb 8, 2011·Transplantation·Shohei FuchinoueSatoshi Teraoka
Jul 31, 2007·Drugs·Nicole A Weimert, Rita R Alloway
Feb 15, 2014·International Urology and Nephrology·Masayuki TasakiKota Takahashi
Mar 25, 2014·Transplantation Proceedings·M TasakiK Takahashi
Aug 21, 2012·Transplantation Reviews·Kota Takahashi, Kazuhide Saito
Jul 10, 2007·Seminars in Nephrology·James ThielkeEnrico Benedetti
Jul 22, 2009·Transplant International : Official Journal of the European Society for Organ Transplantation·Hayato NishidaKazunari Tanabe
Feb 19, 2013·Transplant International : Official Journal of the European Society for Organ Transplantation·A Nicholas R BarnettNizam Mamode
Nov 6, 2013·Transplant International : Official Journal of the European Society for Organ Transplantation·A Nicholas R BarnettNizam Mamode
Jun 28, 2016·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·M TasakiK Takahashi
Oct 14, 2016·Journal of Investigative Surgery : the Official Journal of the Academy of Surgical Research·Jong Man KimSuk-Koo Lee
Mar 2, 2011·Urologia Internationalis·Junji UchidaTatsuya Nakatani
Oct 7, 2019·International Journal of Urology : Official Journal of the Japanese Urological Association·Masayuki TasakiYoshihiko Tomita
Aug 28, 2020·World Journal of Transplantation·Maurizio Salvadori, Aris Tsalouchos

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