genberg.qxp 9/7/07 10:00 am Page 59
Kidney Transplantation
to that of AB0c LD kidney transplantation.
60
Figure 4: Protocol for AB0i Kidney Transplantation
AB0-i kidney transplantation is also performed at a few centres in the
Tacrolimus/MMF/prednisolone
US
61
and Australia. Their protocols are primarily based on plasmapheresis
with or without rituximab. The results are similar to those reported by
Rituximab IVIG
European and Japanese centres. Recent data support that AB0i LD kidney
Glycosorb
transplantation is a superior alternative to DD AB0c transplantation and
1:128
possibly not inferior to LD AB0c transplantation. However, desensitisation
1:64
is associated with an increased cost.
62,63
1:32
1:16
1:8
Cross-match-positive Kidney Transplantation
1:4
HLA antibodies may arise after exposure to foreign tissue, the most
Anti-A IgG titre
1:2
common causes being previous blood transfusion, pregnancy and 1:1
transplantation. Consequently, many of the patients listed for
<1:1
-30 -13 -6 -4 -2 Tx 2 4 6 8 10 12
re-transplantation have HLA antibodies, i.e. they are HLA-sensitised.
Degree of sensitisation is usually measured by the panel reactive
Time (days)
antibody assay (PRA). For broadly sensitised transplant candidates –
those with a high PRA – finding a suitable organ is very difficult. These
Outlines of the protocol for AB0i kidney transplantation using antigen-specific
immunoadsorption and the effect on anti-A antibody titer. The protocol is further described
patients often have to wait for many years. Detection of donor-specific
in: Tyden G, Kumlien G, et al., 2005.
60
HLA antibodies is most commonly achieved by the complement-
Tx = kidney transplantation, MMF = mycophenolate mofetil.
dependent cytotoxicity (CDC) cross-match and the more sensitive
fluorescence-activated cell sorter (FACS) cross-match. A positive cross-
match is generally an absolute contraindication to transplantation. To
overcome this problem, some centres have developed desensitisation dependent cytotoxicity cross-match-positive kidney transplantation is
protocols very similar to those used for AB0i transplantation. The primarily performed at two centres in the US
64,65
and, to a limited
removal of HLA antibodies is carried out either by plasmapheresis or by extent, elsewhere. The results have improved but are still worse than
protein A immunoadsorption. Protein A immunoadsorption is selective those of standard cross-match-negative transplantation. FACS cross-
for immunoglobulins and does not impair coagulation. Complement- match-positive (CDC-negative) transplantations indicating low levels of
GLYCOSORB® ABO
IMMUNOADSORPTION COLUMN
Used in ABO-Incompatible transplantations
Specific removal of anti-A or anti-B antibodies from plasma
Registered in Europe, Turkey and Australia
1. Implementation of a Protocol for ABO- 4. ABO-incompatible live donor renal 7. ABO-mismatch adult living donor liver
Incompatible Kidney Transplantation - A Th- transplantation using blood group A/B transplantation using antigen-specific immu-
ree-Center Experience With 60 Consecutive carbohydrate antigen immunoadsorption noadsorption and quadruple immuno-sup-
Transplantations. and anti-CD20 antibody treatment. pression without splenectomy.
Tydén G., Donauer J., Wadström J., Kumlien G., Nordén G., Briggs D., Cockwell P., Lipkin G., Troisi R., Noens L., Montalti R., Ricciardi S.,
Wilpert J., Nilsson T., Genberg H., Pisarski P., Mjörnstedt L., Mölne J., Ready A., Rydberg L., Philippe J., Praet M., Conoscitore P.,
Tufvesson G. Samuelsson O., Svalander CT., Breimer M. E. Centra M., de Hemptinne B.
Transplantation 15; 83(9):1153-1155 Xenotransplantation 13: 148–153, 2006. Liver Transplantation 2006, March 9.
2. The Stockholm experience with ABO in- 5. ABO-incompatible kidney transplantation 8. ABO-incompatible deceased donor liver
compatible kidney transplantations without using antigen-specific immunoadsorption transplantation with the use of antigen-
splenectomy. and rituximab: a single center experience. specific immunoadsorption and anti-CD20
Tydén G., Kumlien G., Genberg H., Sandberg J., Donauer J., Wilpert J., Geyer M., Schwertfeger E., monoclonal antibody.
Sedigh A., Lundgren T., Gjertsen H., Fehrman I. Kirste G., Drognitz O., Walz G., Pisarski P. Boberg K.M., Foss A., Midtvedt K., Schrumpf E.
Xenotransplantation 13: 105–107, 2007. Xenotransplantation 13: 108–110, 2006. Clin Transplant., 20:2006.
3. ABO incompatible kidney transplantations 6. ABO-incompatible kidney transplantation 9. Heart transplantation across the antibo-
without splenectomy, using antigen-specific of an 8-yr-old girl with donor/recipient-cons- dies against HLA and ABO.
immunoadsorption and rituximab. tellation A1B/B. Bucin D., Johansson S., Malm T., Jögi P.,
Tydén G., Kumlien G., Genberg H., Sandberg J., Ahlenstiel T., Offner G., Strehlau J., Pape L., Johansson J., Bennhagen R.
Lundgren T., Fehrman I. Froede K., Ehrich J., Schwarz A., Heuft H.-G., Transplant International 19:239-244, 2006.
American Journal of Transplantation 5: 145-148, Klempnauer K.
2005. Xenotransplantation 13: 141–147, 2006. 10. ABO-incompatible transplantation —
a safe way to perform renal transplantation?
Sölvegatan 41, 223 70 Lund, Sweden
Beimler J., Zeier M.
Phone: +46 (0) 46 286 57 80, Fax: +46 (0) 46 286 57 81
Nephrology Dialysis Transplantation 2007
22(1):25-27
E-mail:
glycorex@glycorex.ideon.se
TRANSPLANTATION Website:
www.glycorex.com
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