Clinical Outcomes of ABO-Incompatible Kidney Transplant with Rituximab and Double-Filtration Plasmapheresis

Abstract

Objectives: The best treatment for end-stage renal disease is kidney transplant, but the shortage of donor organs has caused long waiting times for an appropriate organ allograft. The use of ABOincompatible kidney transplant can be a valuable option to expand the donor pool. The purpose of the present study was to evaluate 13 patients who had successful ABO-incompatible kidney transplant with double-filtration plasmapheresis and rituximab. Materials and Methods: From January 2011 to August 2012, there were 13 patients who had ABOincompatible kidney transplant. Antibody titers were monitored during preconditioning and after transplant. Preconditioning protocol included rituximab, mycophenolate mofetil, tacrolimus, corticosteroids, double-filtration plasmapheresis, and intravenous immunoglobulin. Results: There were no episodes of acute T-cell or antibody-mediated rejection. There were no surgical complications except postoperative bleeding in 1 patient. Mean serum creatinine at 2 weeks after transplant was 71 ± 18 μmol/L (0.8 ± 0.2 mg/dL). At mean follow-up 267 days (range, 1-19 mo), there was no graft loss or patient death. Conclusions: The ABO-incompatible kidney transplants were successful after the preconditioning protocol that included double-filtration plasmapheresis and rituximab. The use of ABO-incompatible kidney transplant may increase the availability of kidney transplant and avoid or shorten dialysis. Future multicenter studies are justified to develop a standardized preconditioning protocol. Key words: End-stage renal disease, Preconditioning, Rejection, Treatment