ABO-incompatible kidney transplantation with anti-CD20 monoclonal antibodies, intravenous immunoglobulin and plasmapheresis without splenectomy: a case report

A 24-yr-old man was admitted to our hospital for ABO-incompatible kidney transplantation. His blood type was O, and the donor's (his father's) blood type was B. The recipient had pancytopenia, splenomegaly, splenorenal shunts and esophageal varices due to congenital hepatic fibrosis. Therefore, if splenorectomy was performed, the blood pressure of the portal vein and the growth of esophageal varices were predicted. Eventually, in return for splenectomy, anti-CD20 monoclonal antibodies (rituximab), intravenous immunoglobulin and plasmapheresis was performed for additional immunosuppression. Because of progression of pancytopenia, we had to decrease the dose of mycophenolate mofetil and gave up on using deoxyspagalin. Nevertheless the serum creatinine level decreased and remained in the 1.6 to 1.8 mg/dl range.