Role of plasma exchange in ABO-incompatible kidney transplantation

Soohun Yoo, Eun Young Lee, Kyu Ha Huh, Myoung Soo Kim, YuSeun Kim, Hyun Ok Kim

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: In the past, ABO incompatibility was an absolute contraindication for solid organ transplantation. However, multiple recent trials have suggested strategies for overcoming the reactions between graft antigens and recipient antibodies that cause graft rejection. In this study, we determined the usefulness of plasma exchange (PE) for removing anti-A/B antibodies that cause hyperacute/acute humoral graft rejection in patients undergoing ABO-incompatible kidney transplantation. Methods: In our study, 12 patients underwent ABO-incompatible kidney transplantation. All recipients received pre-transplantation conditioning by PE or intravenous immunoglobulin (IVIG) administration. After pre-transplantation conditioning, anti-A/B antibody titers were evaluated, and transplantation was performed when the titer was below 1:8. To assess the transplantation outcome, anti-A/B antibody titers, creatinine level, estimated glomerular fltration rate (eGFR), and proteinuria levels were measured. Results: Anti-A/B antibody titers were below 1:8 in all patients at the time of transplantation. eGFR measured on post-transplant day 14 showed that 10 patients had immediate recovery of graft function, while 2 patients had slow recovery of graft function. Short-term outcomes of ABO-incompatible kidney transplantation (measured as creatinine levels) after reducing anti-A/B antibody titers were similar to those of ABO-compatible kidney transplantation. After transplantation, the anti-A/B antibody titers were below 1:8 in 7 patients, but the remaining 5 patients required post-transplantation PE and IVIG treatment to prevent antigen-antibody reactions. Conclusions: With the increasing demand for kidney donations, interest in overcoming the ABO incompatibility barrier has increased. PE may be an important breakthrough in increasing the availability of kidneys for transplantation.

Original languageEnglish
Pages (from-to)283-288
Number of pages6
JournalAnnals of Laboratory Medicine
Volume32
Issue number4
DOIs
Publication statusPublished - 2012 Jul 1

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Plasma Exchange
Kidney Transplantation
Grafts
Plasmas
Transplantation (surgical)
Antibodies
Transplantation
Transplantation Conditioning
Transplants
Intravenous Immunoglobulins
Recovery of Function
Graft Rejection
Creatinine
Antigen-antibody reactions
Antigen-Antibody Reactions
Recovery
Organ Transplantation
Proteinuria
Intravenous Administration
Availability

All Science Journal Classification (ASJC) codes

  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Yoo, Soohun ; Lee, Eun Young ; Huh, Kyu Ha ; Kim, Myoung Soo ; Kim, YuSeun ; Kim, Hyun Ok. / Role of plasma exchange in ABO-incompatible kidney transplantation. In: Annals of Laboratory Medicine. 2012 ; Vol. 32, No. 4. pp. 283-288.
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Role of plasma exchange in ABO-incompatible kidney transplantation. / Yoo, Soohun; Lee, Eun Young; Huh, Kyu Ha; Kim, Myoung Soo; Kim, YuSeun; Kim, Hyun Ok.

In: Annals of Laboratory Medicine, Vol. 32, No. 4, 01.07.2012, p. 283-288.

Research output: Contribution to journalArticle

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N2 - Background: In the past, ABO incompatibility was an absolute contraindication for solid organ transplantation. However, multiple recent trials have suggested strategies for overcoming the reactions between graft antigens and recipient antibodies that cause graft rejection. In this study, we determined the usefulness of plasma exchange (PE) for removing anti-A/B antibodies that cause hyperacute/acute humoral graft rejection in patients undergoing ABO-incompatible kidney transplantation. Methods: In our study, 12 patients underwent ABO-incompatible kidney transplantation. All recipients received pre-transplantation conditioning by PE or intravenous immunoglobulin (IVIG) administration. After pre-transplantation conditioning, anti-A/B antibody titers were evaluated, and transplantation was performed when the titer was below 1:8. To assess the transplantation outcome, anti-A/B antibody titers, creatinine level, estimated glomerular fltration rate (eGFR), and proteinuria levels were measured. Results: Anti-A/B antibody titers were below 1:8 in all patients at the time of transplantation. eGFR measured on post-transplant day 14 showed that 10 patients had immediate recovery of graft function, while 2 patients had slow recovery of graft function. Short-term outcomes of ABO-incompatible kidney transplantation (measured as creatinine levels) after reducing anti-A/B antibody titers were similar to those of ABO-compatible kidney transplantation. After transplantation, the anti-A/B antibody titers were below 1:8 in 7 patients, but the remaining 5 patients required post-transplantation PE and IVIG treatment to prevent antigen-antibody reactions. Conclusions: With the increasing demand for kidney donations, interest in overcoming the ABO incompatibility barrier has increased. PE may be an important breakthrough in increasing the availability of kidneys for transplantation.

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