The Stockholm experience with ABO-incompatible kidney transplantations without splenectomy

Xenotransplantation
Gunnar TydénIngela Fehrman

Abstract

ABO-incompatible kidney transplantations have previously only been performed after several pre-operative sessions of plasmapheresis followed by splenectomy, and with the conventional triple-drug immunosuppressive protocol being reinforced with anti-lymphocyte globulin and B-cell-specific drugs. We have designed a protocol without splenectomy, based on antigen-specific immunoadsorption, rituximab and a conventional triple-drug immunosuppressive protocol. The protocol called for a 1-month pre-transplantation conditioning period, starting with one dosage of rituximab and followed by full-dose tacrolimus, mycophenolate mofetil and prednisolone. Antigen-specific immunoadsorption was performed on pre-transplantation days -6, -5, -2 and -1. After the last session, 0.5 g/kg of intravenous immunoglobulin (IVIG) was administered. Postoperatively, three more apheresis sessions were given every third day. Twenty-one patients have received transplants with this protocol. The ABO-antibodies (Abs) were readily removed by the antigen-specific immunoadsorption and were kept at a low level post-transplantation by further adsorptions. There were no side effects, and all but one patient have normal renal transplant function. We conclude that after...Continue Reading

References

Apr 17, 2003·Transplantation·James M GloorMark D Stegall
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
Jan 8, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Gunnar TydénIngela Fehrman
Aug 13, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Benjamin E HippenRobert S Gaston

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Citations

Oct 23, 2008·Nature Clinical Practice. Nephrology·Naotsugu Ichimaru, Shiro Takahara
Aug 30, 2008·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Tobias OettlMichael Dickenmann
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Oct 21, 2006·Current Opinion in Nephrology and Hypertension·Tahmina Rahman, Lorraine Harper
Jul 22, 2006·Transplantation·Gunnar Tydén
Jan 25, 2008·Transplantation·Gunnar Tydén
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May 18, 2021·Indian Journal of Nephrology·Vaibhav TiwariD S Rana

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