Incompatible Kidney Transplantation Research Articles

Experience of ABO‐incompatible living kidney transplantation after double filtration plasmapheresis

We achieved success in ABO‐incompatible renal allografting after removing anti‐A and/or anti‐B antibodies from the recipient's plasma using double filtration plasmapheresis (DFPP). We report here the results of our initial 2 cases. Case I was a 40‐yr‐old female whose blood group was A+. The donor was her younger brother, a 37‐yr‐old male, whose blood group was B+. The human lymphocyte antigens. (HLAs) were one haplotype identical, and the stimulation index of the mixed lymphocyte culture (MLC‐SI) was 34. Case 2 was a 28‐yr‐old male whose blood group was B+. The donor was his father, a 58‐yrold male, whose blood group was AB+. The HLAS were one‐haplotype identical as well, and the MLC‐SI was 71. We carried out 4 sessions of DFPP pre‐operatively; i.e. on days 6, 4, 2 and ‐ L. 2.5 1 of plasma were treated with 500 ml of 4.4% plasma protein fraction in each procedure. The pre‐operative target titer of anti‐A/B antibody, measured by the saline tube test, was set at less than × 8. We also used 5 kinds of immunosuppressants. Cyclosporine was administered on day ‐ 2 beginning with 8 mg/kg/d, and its dose was modified according to the trough level. 500 mg of methylprednisolone were administered intravenously during the operation, and prednisolone was started on day 1 with 60 mg/d and tapered. Azathioprine was started on day 2 with 2 mg/kg/d for 7 d and 1 mg/kg/d thereafter. 5 mg/kg/d of gusperimus was given intravenously from day 0 for 5 d. 30 mg/kg/d of ALG was given intravenously from day 0 for 14 d. Along with these immunosuppressants, 0.1 mg/kg/h of nafamostat mesilate was administered intravenously from day 0 for 3 d, and 4 mg/kg/d of ticlopidine was given orally from day 3. X‐Ray irradiation to the renal graft was not done. Following splenectomy standard renal allografting was performed. In Case 1, the titer of anti‐B antibody was reduced from × 16 to × 4. In Case 2, the titer of anti‐A antibody was reduced from × 32 to × 4. The post‐operative courses of these 2 cases were satisfactory. Although our experience is limited, ABO incompatible kidney transplantation can safely be performed using DFPP.

Dra (Cromer‐Related Blood Group Antigen)‐Incompatible Renal Transplantation

Cromer system antigens, a series of blood group antigens of very high frequency, are not considered to be clinically significant in transfusion. In renal transplantation only the ABO blood group antigens are considered essential. The Drori blood group antigen is present in serum and has been found to reside on the renal tubular basement membrane and Bowman's capsule. The effect of anti-Dra on the renal parenchyma has not been evaluated. A unique case of renal transplantation of an incompatible Dr(a+) kidney to a Dr(a-) patient with anti-Dra in her serum is presented. Graft function was immediately good. The titer of anti-Dra remained unchanged following transplantation. The successful outcome of a case of a Drori (Dra)-incompatible kidney transplantation confirmed the lack of clinical significance of the anti-Dra relating to transplantation.

Dra (Cromer-Related Blood Group Antigen)-Incompatible Renal Transplantation

Background and objectives: Cromer system antigens, a series of blood group antigens of very high frequency, are not considered to be clinically significant in transfusion. In renal transplantation only the ABO blood group antigens are considered essential. The Drori blood group antigen is present in serum and has been found to reside on the renal tubular basement membrane and Bowman’s capsule. The effect of anti-Dr^a on the renal parenchyma has not been evaluated. Materials and methods: A unique case of renal transplantation of an incompatible Dr(a+) kidney to a Dr(a–) patient with anti-Dr^a in her serum is presented. Results: Graft function was immediately good. The titer of anti-Dr^a remained unchanged following transplantation. Conclusion: The successful outcome of a case of a Drori (Dr^a)-incompatible kidney transplantation confirmed the lack of clinical significance of the anti-Dr^a relating to transplantation.

ABO Incompatible Kidney Transplantation in Children

We have performed 7 pediatric kidney transplantations from living related donors of ABO incompatibility. All patients preoperatively underwent plasmapheresis with or without immunoadsorption to reduce anti-A and/or anti-B antibodies. Immunosuppression initially consisted of methylprednisolone, cyclosporine, azathioprine, antilymphocyte globulin and deoxyspergualin. At transplantation splenectomy was simultaneously performed in all patients. Median followup is 44 months (range 31 to 58). Patient and graft survival rates are 100 percent to date. There were no uncontrolled vascular rejection episodes, and post-transplant anti-A and/or anti-B antibody titers were always less than 1:32. Transplantation across the ABO blood barrier remains challenging today. However, our small series clearly shows that the preoperative reduction of ABO antibody, simultaneous splenectomy and strict immunosuppressive therapy cause successful long-term results in children.

Characterisation of the anti-A antibody response following an ABO incompatible (A 2 to O) kidney transplantation

Anti-A,B antibodies produced in a blood group OLe(a—b—) recipient receiving a kidney graft from a blood group A 2 Le(a—b + ) donor have been analysed for their ability to bind to different glycosphingolipid antigens. Solid-phase RIA using pure glycosphingolipid antigens and a chromatogram binding assay using total nonacid glycosphingolipid fractions from erythrocytes of different human blood group phenotypes together with pure glycolipid antigens were used as assay systems. Serum antibodies were shown to bind equally well to A (types 1, 2, 3 and 4) and B (types 1 and 2) antigenic structures but no binding to H antigens (types 1, 2 and 4) was detected. After adsorption of serum antibodies on A 1 Le(a—b + ) erythrocytes there was a residual anti-A antibody activity which could not be adsorbed by synthetic A-trisaccharides coupled to crystalline silica (Synsorb®-A). These residual antibodies, which are not present in a pretransplant serum sample, had a specificity for the A antigen with type 1 core saccharide chain and the binding epitope obviously included both the N-acetylgalactosamine and the N-acetylglucosamine. The fucose residue was apparently not obligate for binding. The conformation of the sugar units involved in the binding epitope was determined.

Multicentre trial of ABO-incompatible kidney transplantation

A multicentre study of ABO incompatible kidney transplantation using Biosynsorb was started in Japan in November 1989. A total of 51 cases were registered comprising 23 cases of A incompatibility, 26 cases of B incompatibility and two cases of AB incompatibility. The removal of antibodies (IgG and IgM) was carried out using Biosynsorb in 16 cases, plasmapheresis in four cases and use of both combined in 31 cases. The treatment using Biosynsorb was repeated 3.4 times on average. Serum titres of anti-A (IgG and IgM) antibodies decreased to 4.9 ± 5.0 and 2.7 ± 1.7 and for anti-B titres decreased to 2.8 ± 3.5 and 2.4 ± 3.2. Rejection was found in 33 cases: hyperacute one, accelerated acute five, and acute 27. In two cases rejection was developed concomitantly with a steep elevation in antibody titres. Three patients died, two with functioning grafts. Eight grafts were lost. Patient and graft survivals at 2 years were 94.1% and 84.3%, respectively. From these results it is concluded that: 1. Biosynsorb and plasmapheresis are effective in removing anti-A and anti-B antibodies; 2. graft and patient survivals are similar to those in ABO compatible cases; 3. anti-A and anti-B titres less than 16 are recommended at the time of transplantation; 4. anti-A and anti-B titres higher than 128 may be considered as a risk factor for rejection in the early stages after transplantation.

A successful ABO blood type incompatible kidney transplantation in a child

Transplant InternationalVolume 4, Issue 1 p. 63-64 A successful ABO blood type incompatible kidney transplantation in a child Hiroshi Kawaguchi, Corresponding Author Hiroshi Kawaguchi Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanOffprint requests to: H. KawaguchiSearch for more papers by this authorMotoshi Hattori, Motoshi Hattori Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorKatsumi Ito, Katsumi Ito Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorKota Takahashi, Kota Takahashi Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorTakashi Yagisawa, Takashi Yagisawa Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorTetsuzo Agishi, Tetsuzo Agishi Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorKazuo Ota, Kazuo Ota Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this author Hiroshi Kawaguchi, Corresponding Author Hiroshi Kawaguchi Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanOffprint requests to: H. KawaguchiSearch for more papers by this authorMotoshi Hattori, Motoshi Hattori Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorKatsumi Ito, Katsumi Ito Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorKota Takahashi, Kota Takahashi Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorTakashi Yagisawa, Takashi Yagisawa Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorTetsuzo Agishi, Tetsuzo Agishi Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorKazuo Ota, Kazuo Ota Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this author First published: January 1991 https://doi.org/10.1111/j.1432-2277.1991.tb01948.xCitations: 7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume4, Issue1January 1991Pages 63-64 RelatedInformation

A successful ABO blood type incompatible kidney transplantation in a child

Transplant InternationalVolume 4, Issue 1 p. 63-64 A successful ABO blood type incompatible kidney transplantation in a child Hiroshi Kawaguchi, Corresponding Author Hiroshi Kawaguchi Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanOffprint requests to: H. KawaguchiSearch for more papers by this authorMotoshi Hattori, Motoshi Hattori Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorKatsumi Ito, Katsumi Ito Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorKota Takahashi, Kota Takahashi Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorTakashi Yagisawa, Takashi Yagisawa Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorTetsuzo Agishi, Tetsuzo Agishi Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorKazuo Ota, Kazuo Ota Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this author Hiroshi Kawaguchi, Corresponding Author Hiroshi Kawaguchi Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanOffprint requests to: H. KawaguchiSearch for more papers by this authorMotoshi Hattori, Motoshi Hattori Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorKatsumi Ito, Katsumi Ito Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorKota Takahashi, Kota Takahashi Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorTakashi Yagisawa, Takashi Yagisawa Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorTetsuzo Agishi, Tetsuzo Agishi Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this authorKazuo Ota, Kazuo Ota Department of Pediatric Nephrology, Urology and Surgery, Kidney Center, Tokyo Women's Medical College, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JapanSearch for more papers by this author First published: January 1991 https://doi.org/10.1111/j.1432-2277.1991.tb01948.xCitations: 7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume4, Issue1January 1991Pages 63-64 RelatedInformation

Long-term Incompatible Kidney Survival in Outbred Higher Primates without Chronic Immunosuppression

Transplantation between non-identical humans has been limited by the requirement for chronic immunosuppression (CI). This study demonstrates in a nonhuman primate model that long-term acceptance of incompatible kidney allografts can be achieved without the use of CI. Following incompatible kidney transplantation, rhesus monkey recipients were given a 5-day course of clinical rabbit antithymocyte globulin (RATG). On day 12, unfractionated donor bone marrow (BM) was infused intravenously. Recipients were monitored for T-cell levels and T-cell subset levels with monoclonal antibodies and for responses in one way MLR. Graft survival in untreated control animals was 9.2 +/- 2.8 days. In six animals given RATG only, all died of rejection at a mean 35.8 +/- 5.7 days. Of five animals given RATG and donor BM (mean 2.5 RhLA mismatches, mean MLC 12.7), four are alive at 150 days, 248 days, 342 days, and 401 days (median 248 days). The ATG-BM infused group showed a prolonged imbalance of their OKT4/OKT8 cell ratio and cellular suppression of MLR responsiveness. The long-term survival obtained in these outbred primates is apparently due to a synergistic immunoregulatory effect induced by the RATG and donor BM. The model described is apparently the first report of long-term survival of outbred higher primates without CI and may represent a technique for producing tolerance without CI in the human.

Induced immune destruction of long-surviving, H-2 incompatible kidney transplants in mice

induced immune destruction of long-surviving, H-2 incompatible kidney transplants in mice

Induced immune destruction of long-surviving, H-2 incompatible kidney transplants in mice.

Induced immune destruction of long-surviving, H-2 incompatible kidney transplants in mice.