Immune desensitization allows pediatric blood group incompatible kidney transplantation

Jelena Stojanovic, Anna Adamusiak, Nicos Kessaris, Pankaj Chandak, Zubir Ahmed, Neil J. Sebire, Grainne Walsh, Helen E. Jones, Stephen D. Marks, Nizam Mamode

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background. Blood group incompatible transplantation (ABOi) in children is rare as pretransplant conditioning remains challenging and concerns persist about the potential increased risk of rejection. Methods.We describe the results of 11 ABOi pediatric renal transplant recipients in the 2 largest centers in the United Kingdom, sharing the same tailored desensitization protocol. Patients with pretransplant titers of 1 or more in 8 received rituximab 1 month before transplant; tacrolimus and mycophenolate mofetil were started 1 week before surgery. Antibody removal was performed to reduce titers to 1 or less in 8 on the day of the operation. No routine postoperative antibody removal was performed. Results. Death-censored graft survival at last follow-up was 100% in the ABOi and 98% in 50 compatible pediatric transplants. One patient developed grade 2A rejection successfully treated with antithymocyte globulin. Another patient had a titer rise of 2 dilutions treated with 1 immunoadsorption session. There was no histological evidence of rejection in the other 9 patients. One patient developed cytomegalovirus and BK and 2 others EBV and BK viremia. Conclusions. Tailored desensitization in pediatric blood group incompatible kidney transplantation results in excellent outcomes with graft survival and rejection rates comparable with compatible transplants.

Original languageEnglish (US)
Pages (from-to)1242-1246
Number of pages5
JournalTransplantation
Volume101
Issue number6
DOIs
StatePublished - Jun 2017

Bibliographical note

Funding Information:
N.M. acknowledges financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

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