ABO Incompatible Kidney Transplantation Without Plasmapheresis and/or Plasma Exchange, Immunoadsorption and IVIG.

[Aim] The aim of this study is to evaluate whether ABO incompatible kidney transplant (ABOi) recipients with low titer of anti-donor blood group antibody (ADBGAB) need plasmapheresis (PP) and/or plasma exchange (PE), immunoadsorption (IA) and IVIG pre- and post-transplantation (Tx). [Methods] Ten ABOi recipients were entered in this study. The low titer of ADBGAB was defined below 32 folds or equal (≤ x32). As desensitization, rituximab 100mg was administered 10 days and 1 day before Tx. Mycophenolate mofetile (MMF) 20mg/kg/day, methylprednisolone (MP) 8-16 mg/day and cyclosporine (CyA) or tacrolimus (FK) were given from 10 to 0 day before Tx. CyA and FK doses were adjusted in terms of trough level, 200 and 10 ng/ml, respectively pre-Tx. All 10 recipients never had PP and/or PE, IA and IVIG pre- and post-Tx. Immunosuppression was consisted of basiliximab, CyA (n=5) or FK (n=5), MMF and MP post-Tx. Clinical acute rejection, subclinical rejection and viral infections were studied. [Patient Background] The recipient and the donor ages at Tx were 31.4 ± 16.0 (4˜52) and 50.4 ± 10.0 (37˜60) years, respectively. The recipient and the donor genders were 8 and 3 males, respectively. No recipients had donor specific HLA antibody. ABO incompatible matches were 4 (A to B), 2(B to O), 1 (A to O), 2 (AB to B) and 1 (AB to A). The titers of ADBGAB pre-Tx were x32 in 1, x8 in 1, x2 in 3, and x1 in 5 recipients. The relations of donor to recipient were 4 mothers, 2 fathers, 2 wives, 1 brother and 1 sister. HLA mismatches were 5 in 1, 3 in 3, 2 in 4, 1 in 1 and 0 in 1 recipients. [Result] All 10 recipients have so far survived and kept good renal function (recent serum Cr; 0.3 ˜ 1.67mg/dl). The mean of post-Tx period was 14 months (2˜40 months). The highest titers of ADBGAB were x8 in 2 and x1 in 8 recipients post-Tx. All 10 recipients never had clinical acute rejection. Protocol biopsy showed borderline change in 1 recipient at 3 and 12 months post-Tx. CMV infection without any symptoms was diagnosed by antigenemia method in 1 recipient. BK virus was positive in urine but not in blood in 1 recipient. One recipient had herpes zoster infection. Leukopenia (WBC≤2000) occurred in 2 recipients. [Conclusion] ABOi recipients with low titer of ADBGAB do not need PP and/or PE, IA and IVIG pre- and post-Tx.