Journal ArticleDOI
Bleeding complications in pediatric ABO-incompatible kidney transplantation
Betti Schaefer,Burkhard Tönshoff,Jan Schmidt,Mohammad Golriz,Arianeb Mehrabi,Petra Gombos,Christian Morath,Elke Wühl,Franz Schaefer,Claus Peter Schmitt +9 more
TLDR
ABOi-RTx can successfully be performed in pediatric patients after preconditioning with quadruple immunosuppression, rituximab and IA, andCaution is required regarding bleeding complications, which are most likely due to the unspecific binding of coagulation factors during repeated IA.Abstract:
ABO-incompatible renal transplantation (ABOi-RTx) following preconditioning with immunoadsorption (IA) and rituximab is a promising approach to facilitate living-related RTx. However, clinical experience is limited in pediatric patients. Three patients underwent living-related ABOi-RTx in our center. Preoperative IA was performed six, ten and 11 times in patient one, two and three, respectively, to achieve isoagglutinin titers of ≤1:8 on the day of transplantation; rituximab was administered once. The immunosuppressive regimen further comprised tacrolimus, mycophenolate, methylprednisolone and basiliximab; immunoglobulin G (IgG) was infused on the day of ABOi-RTx. All three patients achieved normal renal function within 2–6 days post-RTx. Major postoperative bleeding occurred in two patients, with one requiring repeated blood transfusions and the other a surgical revision 4 h after RTx, despite local citrate anticoagulation use during the preoperative IA procedures in the latter patient. A pyelonephritis-associated increase of the isoagglutinin IgG/IgM titers to 1:64/1:128 led to a biopsy-proven acute humoral rejection in the third patient, which was treated successfully with plasma exchange and methylprednisolone pulses. The estimated glomerular filtration rate at 18, 8 and 23 months post-RTx was 96, 52 and 74 ml/min/1.73 m2, respectively. ABOi-RTx can successfully be performed in pediatric patients after preconditioning with quadruple immunosuppression, rituximab and IA. Caution is required regarding bleeding complications, which are most likely due to the unspecific binding of coagulation factors during repeated IA.read more
Citations
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Journal ArticleDOI
ABO-Incompatible Kidney Transplantation.
TL;DR: There is still concern, however, that infectious complications such as viral disease, Pneumocystis jirovecii pneumonia, and severe urinary tract infections are increased after ABOi transplantations.
Journal ArticleDOI
Early clinical complications after ABO incompatible live donor kidney transplantation: A national study of Medicare-insured recipients
Krista L. Lentine,David A. Axelrod,Christina L. Klein,Christopher Simpkins,Huiling Xiao,Mark A. Schnitzler,Janet E. Tuttle-Newhall,Vikas R. Dharnidharka,Daniel C. Brennan,Dorry L. Segev +9 more
TL;DR: ABOi transplantation offers patients with potential live donors an additional transplant option but with higher risks of infectious and hemorrhagic complications, and awareness of these complications may help improve protocols for the management of ABOi transplation.
Journal ArticleDOI
Strategies to overcome the ABO barrier in kidney transplantation.
TL;DR: A continuous improvement in desensitization strategies, with the aim of minimizing the immunosuppressive burden, might pave the way to clinical outcomes that are comparable to those achieved in ABO-compatible transplantation.
Journal ArticleDOI
Outcomes Following ABO-Incompatible Kidney Transplantation Performed After Desensitization by Nonantigen-Specific Immunoadsorption.
Luis E. Becker,Daniela Siebert,Caner Süsal,Gerhard Opelz,Albrecht Leo,Rüdiger Waldherr,Stephan Macher-Goeppinger,Peter Schemmer,Sebastian Markus Schaefer,Katrin Klein,Jörg Beimler,Martin Zeier,Vedat Schwenger,Christian Morath +13 more
TL;DR: Clinical outcomes of ABO-incompatible patients desensitized with a nonantigen-specific IA device and rituximab do not differ from that of matched A BO-compatible patients although a trend toward reduced patient survival was noted.
Journal ArticleDOI
An update on ABO-incompatible kidney transplantation.
Stefan Zschiedrich,Albrecht Kramer-Zucker,Bernd Jänigen,Maximilian Seidl,Florian Emmerich,Przemyslaw Pisarski,Tobias B. Huber,Tobias B. Huber +7 more
TL;DR: Most recent data show excellent graft survival rates equivalent to ABO‐compatible kidney transplantation outcome, despite isohaemagglutinin reappearance, C4d positivity of peritubular capillaries as well as the increased incidence of bleeding complications.
References
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New Equations to Estimate GFR in Children with CKD
George J. Schwartz,Alvaro Muñoz,Michael F. Schneider,Robert H. Mak,Frederick J. Kaskel,Bradley A. Warady,Susan L. Furth +6 more
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Journal ArticleDOI
Excellent long-term outcome of ABO-incompatible living donor kidney transplantation in Japan.
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TL;DR: Long‐term outcome in recipients of ABO‐incompatible living kidneys is excellent, and graft survival rates were significantly higher in patients 29 years or younger than in patients 30 years or older and in patients who received anticoagulation therapy than in those who did not receive such therapy.
Guideline Development Group
Andrew Elder,Richard Davenport,Roderick Duncan,Consultant Neurologist,Susan Duncan,John Paul Leach,Damien Reid,Pamela Parker +7 more
Journal ArticleDOI
Successful ABO-incompatible kidney transplantations without splenectomy using antigen-specific immunoadsorption and rituximab.
TL;DR: In this article, the authors evaluated a protocol for ABO-incompatible kidney transplantation without splenectomy using antigen-specific immunoadsorption, rituximab, and a conventional triple-drug immunosuppressive regimen.
Journal ArticleDOI
Implementation of a Protocol for ABO-incompatible kidney transplantation--a three-center experience with 60 consecutive transplantations.
Gunnar Tydén,Johannes Donauer,Jonas Wadström,Gunilla Kumlien,Jochen Wilpert,Thomas Nilsson,Helena Genberg,Przemislaw Pisarski,Gunnar Tufveson +8 more
TL;DR: A significant inter-institutional variation in the measurement of anti-AB-antibodies was found, having a substantial impact on the number of immunoadsorptions and consequently on the total cost for the procedure.