The antiviral medication baragancyclovir was initiated and the dose of MMF was decreased to 1000?mg/day. not meet Rabbit Polyclonal to Collagen XIV alpha1 our target of less than 128-fold dilution. MMF was thus continued for an additional 4 months and four additional sessions of plasmapheresis were undertaken. Following these interventions, antibody titers decreased to 128-fold dilution and ABO-iLKT was performed. Following transplant, antibody-mediated rejection was not observed and renal function was preserved. However, a post-operative renal biopsy 1.5?months later showed evidence of T-cell-mediated rejection IB. The patient was treated with steroids, with no increase in serum creatinine. Conclusion Our findings suggest that the long-term single MMF desensitization therapy could be a suitable option for ABO-iLKT with high refractory and rebound anti-blood type antibody. Further studies are required to establish the optimal immunosuppression regimen to control B cell- mediated immunity in ABO-iLKT. Keywords: ABO-incompatible living related kidney transplantation, Anti-blood type antibody, B-cell immunity, Mycophenolate mofetil Background Kidney transplantation is the most effective renal replacement therapy for improving mortality and quality of life [1]. However, while the number of patients waiting for a donor kidney is usually increasing, there is a Palovarotene shortage of organ transplantation donors [2]. One strategy to address this problem is usually ABO-incompatible living related kidney transplantation (ABO-iLKT). ABO-iLKT has the potential to expand the opportunities Palovarotene for kidney transplantation. This transplantation method has been performed since 1982, and Opelz et al. reported on 1420 patients who received ABO-incompatible kidney grafts between 2005 and 2012 [3]. ABO-iLKT has been successful, in part, because of the identification of immunological mechanisms following the procedure, including accommodation, humoral rejection, and cellular rejection [4, 5]. The maintenance of a vascularized graft despite the presence of anti-blood-group antibodies is usually termed accommodation [4]. Accommodation can be established with pre- and post-transplant conditioning regimens. Despite the development of modern conditioning treatments, some patient populations continue to have a high risk of transplant rejection. Our report describes the clinical course of a patient undergoing ABO-iLKT with refractory high-titer (anti-A blood-type IgG antibody titer: 4096-fold dilution) and rebound anti-blood type antibody. We discuss the influence of long-term desensitization therapy on kidney transplantation in comparable high-risk patients. Case presentation A 60-year-old man was referred to our hospital for kidney transplantation. His wife, a 59-year-old woman, volunteered to donate her kidney to him when he started hemodialysis at age 59. The proposed transplant was ABO incompatible, from a donor with blood-type A to a recipient with blood-type O, and the recipients anti-A blood-type IgG antibody titer was measured at 4096-fold dilution. Preoperative testing included HLA-DNA typing, which revealed a Palovarotene mismatch in 6 Palovarotene antigens. Initial flow cytometric crossmatch testing (FCXM) was unfavorable. Moreover, the flow cytometric panel reactive antibody (Flow PRA) screening test was unfavorable for human leukocyte antigen (HLA) class I and class II. Single antigen testing was also unfavorable. Three months prior to medical procedures, mycophenolate mofetil (MMF) 750?mg/day was initiated and the anti-CD20 monoclonal antibody Rituximab (200?mg) was administered according to our pre-transplantation regimen (Fig.?1). Following 3 months of desensitization therapy, the patient underwent two sessions of double filtration plasmapheresis (DFPP). Open in a separate window Fig. 1 Patients clinical course and laboratory data: serum creatinine, anti-blood type A antibody titers, and IgG Anti-blood type antibody titers (IgG/IgM) were then assayed using the column agglutination technology (gel microcolumn) method (Bio-Rad?, Japan). Our target antibody titer level was
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