Abstract
Blood group antigens of the ABO-type are expressed with broad tissue distribution, including endothelial, epithelial and red blood cells. This has traditionally restricted solid organ transplantation to major ABO compatibility. We therefore asked, if this barrier could be overcome by isoagglutinin apheresis before transplantation.
In four patients on dialysis with ABO incompatible living related ...
Abstract
Blood group antigens of the ABO-type are expressed with broad tissue distribution, including endothelial, epithelial and red blood cells. This has traditionally restricted solid organ transplantation to major ABO compatibility. We therefore asked, if this barrier could be overcome by isoagglutinin apheresis before transplantation.
In four patients on dialysis with ABO incompatible living related donors, apheresis was performed with Cobe Spectra and Adasorb using Glycosorb columns. In addition, patients received Rituximab (Anti-CD20) for B cell depletion before transplantation. Isoagglutinin titers were determined at baseline, before and after apheresis, and after transplantation.
The isoagglutinin titers at baseline were 8 to 128 (IgG), and 1 to 32 (IgM). Apheresis resulted in a median reduction of 3 titer steps, and 5 (median) procedures were required prior to transplantation. In all patients titers could be reduced to 4 or less before transplantation, and all grafts could be transplanted successfully with excellent function. Isoagglutinin titers remained low (4 or less) after transplantation.
ABO-incompatible living donor renal transplantation may be facilitated by prior isoagglutinin apheresis.
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