Successful living donor renal transplantation despite ABO incompatibility and a positive crossmatch

Authors: Kayler, Liise K.1; Colombe, Beth2; Farber, John L.3; LaCava, Deborah2; Dafoe, Donald C.1; Burke, James F.2; Francos, George C.2; Ratner, Lloyd E.1

Source: Clinical Transplantation, Volume 18, Number 6, December 2004 , pp. 737-742(6)

Publisher: Blackwell Publishing

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Abstract:

Kayler LK, Colombe B, Farber JL, LaCava D, Dafoe DC, Burke JF, Francos GC, Ratner LE. Successful living donor renal transplantation despite ABO incompatibility and a positive crossmatch.

Clin Transplant 2004 DOI: 10.1111/j.1399-0012.2004.00259.x

© Blackwell Munksgaard, 2004 Abstract: 

Potential live kidney donors have been rejected when the prospective recipients are blood type or crossmatch incompatible. By utilizing plasmapheresis combined with intravenous immune globulin (PP/IVIg) prior to surgery, donor-specific antibodies against blood group or human leukocyte antigens (HLA) have been removed, thereby allowing successful renal transplantation. A 26-yr-old male with a panel reactive antibody level of 100% and repeated positive crossmatches against deceased donor kidney offers, including zero HLA mismatched donors, successfully underwent ABO-incompatible kidney transplantation from his HLA-identical but nevertheless crossmatch-incompatible sister. The initial anti-A blood group isoagglutinin titers were 128, 256, and 1024 at room temperature, 37°C, and 37°C anti-IgG enhanced, respectively. With an individualized PP/IVIg regimen based on donor-specific antibody titer, however, the relevant antibodies were adequately reduced and hyperacute rejection avoided. Subsequent antibody-mediated rejection, likely directed against a minor histocompatibility antigen, was diagnosed on postoperative day 7 and successfully treated. Neither ABO, or crossmatch incompatibility, or both in combination prohibit kidney transplantation.

Keywords: ABO incompatible; kidney transplantation; positive crossmatch

Document Type: Research article

DOI: 10.1111/j.1399-0012.2004.00259.x

Affiliations: 1:  Surgery 2:  Medicine 3:  Pathology, Thomas Jefferson University, Philadelphia, PA, USA

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