TY - JOUR
T1 - Tailored desensitization strategies in ABO blood group antibody incompatible renal transplantation
AU - Barnett, A. Nicholas R.
AU - Manook, Miriam
AU - Nagendran, Myura
AU - Kenchayikoppad, Shivakumar
AU - Vaughan, Robert
AU - Dorling, Anthony
AU - Hadjianastassiou, Vassilis G.
AU - Mamode, Nizam
PY - 2014/2
Y1 - 2014/2
N2 - ABO blood group incompatible renal transplantation, using desensitization procedures, is an effective strategy. Efforts have been made to reduce desensitization: these are usually applied to all patients indiscriminately. The Guy's Hospital ABO blood group incompatible desensitization regimen uses a tiered approach, tailoring strategy according to initial antibody titres. Sixty-two ABO blood group incompatible living donor transplant recipients were compared with 167 recipients of blood group compatible living donor renal transplants. There were no statistically significant differences in allograft survival rates at 1 or 3 years post-transplant, rejection in the first year post-transplant or renal function in the first 3 years post-transplant. There was a higher rate of death in ABO blood group incompatible transplant recipients - this could be associated with differences in age and HLA mismatch between the two groups. Four ABO blood group incompatible patients experienced antibody-mediated rejection (no episode was associated with a rise in ABO blood group antibodies). Of the patients who received no desensitization, or rituximab alone, none has experienced antibody mediated rejection or experienced allograft loss. Tailoring the use of desensitization in ABO blood group incompatible renal transplantation according to initial ABO blood group antibody titres led to comparable results to blood group compatible transplantation.
AB - ABO blood group incompatible renal transplantation, using desensitization procedures, is an effective strategy. Efforts have been made to reduce desensitization: these are usually applied to all patients indiscriminately. The Guy's Hospital ABO blood group incompatible desensitization regimen uses a tiered approach, tailoring strategy according to initial antibody titres. Sixty-two ABO blood group incompatible living donor transplant recipients were compared with 167 recipients of blood group compatible living donor renal transplants. There were no statistically significant differences in allograft survival rates at 1 or 3 years post-transplant, rejection in the first year post-transplant or renal function in the first 3 years post-transplant. There was a higher rate of death in ABO blood group incompatible transplant recipients - this could be associated with differences in age and HLA mismatch between the two groups. Four ABO blood group incompatible patients experienced antibody-mediated rejection (no episode was associated with a rise in ABO blood group antibodies). Of the patients who received no desensitization, or rituximab alone, none has experienced antibody mediated rejection or experienced allograft loss. Tailoring the use of desensitization in ABO blood group incompatible renal transplantation according to initial ABO blood group antibody titres led to comparable results to blood group compatible transplantation.
KW - ABO incompatibility
KW - immunoadsorption
KW - kidney transplantation
KW - monoclonal antibodies
KW - plasmapheresis
UR - http://www.scopus.com/inward/record.url?scp=84892187436&partnerID=8YFLogxK
U2 - 10.1111/tri.12234
DO - 10.1111/tri.12234
M3 - Article
C2 - 24188566
AN - SCOPUS:84892187436
SN - 0934-0874
VL - 27
SP - 187
EP - 196
JO - Transplant International
JF - Transplant International
IS - 2
ER -