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Desensitization With Plasmapheresis and Anti-Cd20 for ABO Incompatible Kidney Transplantation From Living Donor: Experience of a Single Center in Italy
Authors:C. Silvestre  L. Furian  P. Marson  T. Tison  M. Valente  F. Marchini  B. Rossi  L. Bonfante  F. Valerio  E. Cozzi  P. Rigotti
Affiliation:1. Kidney and Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy;2. Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua, Italy;3. Institute of Pathology, A.O.U. of Padua, Padua, Italy;4. Nephrology Unit, University Hospital of Padua, Padua, Italy;5. Division of Nephrology, Spedali Civili di Brescia, Brescia, Italy;6. CORIT (Consortium for Research in Organ Transplantation), Padua, Italy;g Clinical and Experimental Transplantation Immunology, University Hospital of Padua, Padua, Italy
Abstract:

Objective

Blood group incompatibility in kidney transplants from a living donor can be successfully overcome by using various desensitization protocols: intravenous immunoglobulin, plasmapheresis (PP), immunoadsorption, and double filtration PP.

Patients and Methods

From July 2010 to October 2013, we performed 10 ABO incompatible kidney transplantation (KT) procedures from a living donor. The desensitization protocol was based on rituximab and PP + cytomegalovirus immune globulin. All patients received induction with basiliximab, except 1 case treated with Thymoglobuline® (ATG) for the simultaneous presence of donor-specific antibody. Tacrolimus and mycophenolate mofetil were initiated at the time of desensitization and continued after the transplant.

Results

After a mean follow-up of 11.6 ± 10.4 months, all patients are alive with a functioning graft. The mean serum creatinine concentration at 1 month, 3 months, 6 months, and 1 year was 1.48 ± 0.29, 1.47 ± 0.18, 1.47 ± 0.27, and 1.5 ± 0.27 mg/dl. Three episodes of acute cellular rejection occurred in 2 patients. There was only 1 case of BK virus infection, treated with reduction of immunosuppressive therapy. The protocol biopsy specimens at 1, 3, and 6 months were C4d positive in the absence of acute rejection.

Conclusions

Desensitization with rituximab, PP, and anti–cytomegalovirus immune globulin allowed us to perform transplants from living donors to ABO incompatible recipients with excellent results and reduced costs.
Keywords:
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