ABO-incompatible kidney transplantation without pre-operative antibody removal therapy

Abstract

【Objective】We performed ABO incompatible kidney transplantation (ABOiKt) without pre-operative antibody removal and assessed the outcome.【Methods】In 13 cases with low antibody titer (32 or lower), ABOiKt was performed without pre-operative antibody removal, a procedure conventionally done by double filtration plasmapheresis. We utilized two doses of rituximab (100mg/body, on day-8/-1) combined with mycophenolate mofetil (MMF)/methylprednisolone started 2 weeks before surgery as a desensitization therapy. Calcineurin inhibitor was started 3 days before surgery. Two doses of basiliximab were also utilized.【Results】Although acute cellular rejection occurred in 3 cases, no patient experienced antibody mediated rejection, which was caused by anti-blood group antibody. Average serum creatinine was 1.4±0.4 (0.68～2.08) mg/dL (mean observational period 794±516 (180～1,801day)).【Conclusion】In cases of ABOiKt with low baseline anti-blood group antibody (32 or lower), short term outcome of kidney transplant without pre-operative antibody removal therapy is satisfactory.