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https://www.readbyqxmd.com/read/28792635/favorable-results-in-abo-incompatible-renal-transplantation-without-b-cell-targeted-therapy-advantages-and-disadvantages-of-rituximab-pretreatment
#1
Manabu Okada, Yoshihiko Watarai, Kenta Iwasaki, Kenta Murotani, Kenta Futamura, Takayuki Yamamoto, Takahisa Hiramitsu, Makoto Tsujita, Norihiko Goto, Shunji Narumi, Asami Takeda, Kunio Morozumi, Kazuharu Uchida, Takaaki Kobayashi
The effectiveness of desensitization with rituximab in ABO-incompatible renal transplantation (ABO-I) has been widely reported. However, ABO-I outcomes are still worse than those of ABO-identical or ABO-compatible renal transplantation (ABO-Id/C). We retrospectively examined the outcomes in consecutive living donor ABO-Id/C (n = 412) and ABO-I (n = 205) cases to elucidate the causes of inferiority in ABO-I. ABO-I cases included recipients treated with rituximab (RIT, n = 131), splenectomy (SPX, n = 21), or neither because of low anti-A/B antibody titers (NoR/S, n = 53)...
August 9, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28635356/simultaneous-abo-incompatible-living-donor-liver-transplantation-and-splenectomy-without-plasma-exchange-in-china-two-case-reports
#2
Guoyong Chen, Janjun Sun, Sidong Wei, Yongfeng Chen, Gaofeng Tang, Zhantao Xie, Huaen Xu, Janbin Chen, Huibo Zhao, Zhenhua Yuan, Weiwei Wang, Guangbo Liu, Bing Wang, Biao Niu
ABO-incompatible (ABO-i) living-donor liver transplantation (LDLT) is performed if an ABO-compatible graft cannot be obtained. However, a perfect desensitization protocol has not been established worldwide, especially for simultaneous ABO-i LDLT and splenectomy. We herein report two cases of ABO-i LDLT. To the best of our knowledge, this is the first case report of ABO-i LDLT in an adult patient in China. Splenectomy and T-cell-targeted immunosuppression (basiliximab) was used to overcome the blood group barrier in these recipients...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28512755/evaluation-of-safety-of-concomitant-splenectomy-in-living-donor-liver-transplantation-a-retrospective-study
#3
Amr Badawy, Yuhei Hamaguchi, Seo Satoru, Tochimi Kaido, Hideaki Okajima, Shinji Uemoto
In Asian countries, concomitant splenectomy in living donor liver transplantation (LDLT) is indicated to modulate the portal vein pressure in the small-sized graft to protect against small for size syndrome. While concomitant splenectomy in deceased donor liver transplantation is almost contraindicated based on Western Reports of increased mortality and morbidity rate due to septic complications, there are few studies about that in LDLT. So, we retrospectively investigated the clinical outcome of adult LDLT at Kyoto University Hospital from July 2010 to July 2016...
September 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28002655/optimal-dosage-regimen-for-rituximab-in-abo-incompatible-living-donor-liver-transplantation
#4
Hiroto Egawa, Koji Umeshita, Shinji Uemoto
BACKGROUND: Rituximab has greatly improved the outcomes of ABO-incompatible living donor liver transplantation (ABO-I LDLT). To clarify the optimal regimen for rituximab in adult ABO-I LDLT, a multicenter study was conducted in Japan. METHODS: Clinical data of 33 adult patients undergoing ABO-I LDLT at 15 centers in 2013 were retrospectively corrected. RESULTS: The targeted blood type was A1 in 18, B in 14, and AB in one patient. Rituximab was administered at 7 to 48 days before LT, at a dose of 375 mg/m(2) in 12 patients, 500 mg in 15 patients, 300 mg in five patients, and 100 mg in one patient...
February 2017: Journal of Hepato-biliary-pancreatic Sciences
https://www.readbyqxmd.com/read/27534951/results-of-a-multicenter-prospective-clinical-study-in-japan-for-evaluating-efficacy-and-safety-of-desensitization-protocol-based-on-rituximab-in-abo-incompatible-kidney-transplantation
#5
Kota Takahashi, Kazuhide Saito, Shiro Takahara, Shohei Fuchinoue, Takashi Yagisawa, Atsushi Aikawa, Yoshihiko Watarai, Norio Yoshimura, Kazunari Tanabe, Kunio Morozumi, Motohide Shimazu
BACKGROUND: Deceased organ donations are rare in Japan, with most kidney transplants performed from a limited number of living donors. Researchers have thus developed highly successful ABO-incompatible transplantation procedures, emphasizing preoperative desensitization and postoperative immunosuppression. A recent open-label, single-arm, multicenter clinical study prospectively examined the efficacy and safety of rituximab/mycophenolate mofetil desensitization in ABO-incompatible kidney transplantation without splenectomy...
August 2017: Clinical and Experimental Nephrology
https://www.readbyqxmd.com/read/27495772/histological-and-extended-clinical-outcomes-after-abo-incompatible-renal-transplantation-without-splenectomy-or-rituximab
#6
Kevin V Chow, Shaun M Flint, Angeline Shen, Anthony Landgren, Moira Finlay, Anand Murugasu, Rosemary Masterson, Peter Hughes, Solomon J Cohney
BACKGROUND: Excellent short-term results have been reported in ABO-incompatible (ABOi) renal transplant recipients managed solely with antibody removal and conventional immunosuppression. However, long-term clinical outcomes with this regimen and predictive information from protocol biopsies are lacking. METHODS: We compared outcome data in ABOi and ABO-compatible (ABOc) recipients receiving this regimen approximately 4 years posttransplant, and histology from biopsies approximately 12 months posttransplant...
June 2017: Transplantation
https://www.readbyqxmd.com/read/27374679/successful-long-term-graft-survival-of-a-renal-transplantation-patient-with-wiskott-aldrich-syndrome
#7
Kotaro Kai, Maki Sumida, Yaeko Motoyoshi, Yuichi Ogawa, Katsuyuki Miki, Kazuhiro Iwadoh, Akihito Sannomiya, Toru Murakami, Ichiro Koyama, Kumiko Kitajima, Ichiro Nakajima, Tomohiro Morio, Shohei Fuchinoue
Wiskott-Aldrich syndrome, a rare X-linked hereditary syndrome, is characterized by immunodeficiency, thrombocytopenia, and eczema. The underlying T-cell defect renders renal transplantation and immunosuppressive treatments uncertain. The present case exhibited the mild clinical manifestation, regarded as X-linked thrombocytopenia. He successfully underwent a living-donor ABO-compatible renal transplantation and splenectomy in 2002, and thereafter experiencing no severe rejection, serious infection, or malignancy for more than 10 years...
2016: Internal Medicine
https://www.readbyqxmd.com/read/27320573/single-center-experience-of-abo-incompatible-living-donor-liver-transplantation-with-a-new-simplified-intravenous-immunoglobulin-protocol-a-propensity-score-matching-analysis
#8
J D Kim, D L Choi, S-G Kim, A-J Lee
The outcomes of patients who undergo ABO-incompatible (ABO-I) living-donor liver transplantation (LDLT) have markedly improved as strategies have become more innovative and advanced. Here, we describe 25 cases of ABO-I LDLT with a simplified protocol and compare the outcomes to those of ABO-compatible LDLT. We analyzed outcomes via a retrospective review of 182 adult LDLT cases including 25 ABO-I LDLTs from January 2011 to December 2014. Propensity scoring was used to compare the groups. The desensitization protocol included plasma exchange, rituximab, and intravenous immunoglobulin without local infusion therapy...
May 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27231173/individualized-immunosuppressive-protocol-of-liver-transplant-recipient-should-be-made-based-on-splenic-function-status
#9
Ji-Yong Song, Guo-Sheng Du, Li Xiao, Wen Chen, Long-Long Suo, Yu Gao, Li-Kui Feng, Bing-Yi Shi
BACKGROUND: Lymphocyte subsets play important roles in rejection in liver transplant recipients, and the effect of splenic function on these roles remains unknown. The aim of this study was to explore the feasibility to adjust immunosuppressive agents based on splenic function status through detecting the lymphocyte subsets in liver transplantBeijing recipients. METHODS: The lymphocyte subsets of 49 liver transplant recipients were assessed in the 309th Hospital of Chinese People's Liberation Army between June 2014 and August 2015...
June 5, 2016: Chinese Medical Journal
https://www.readbyqxmd.com/read/27214874/splenic-irradiation-for-the-treatment-of-severe-antibody-mediated-rejection
#10
B J Orandi, B E Lonze, A Jackson, S Terezakis, E S Kraus, N Alachkar, S M Bagnasco, D L Segev, J B Orens, R A Montgomery
Patients requiring desensitization prior to renal transplantation are at risk for developing severe antibody-mediated rejection (AMR) refractory to treatment with plasmapheresis and intravenous immunoglobulin (PP/IVIg). We have previously reported success at graft salvage, long-term graft survival and protection against transplant glomerulopathy with the use of eculizumab and splenectomy in addition to PP/IVIg. Splenectomy may be an important component of this combination therapy and is itself associated with a marked reduction in donor-specific antibody (DSA) production...
October 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27115002/feasible-usage-of-abo-incompatible-grafts-in-living-donor-liver-transplantation
#11
Toru Ikegami, Tomoharu Yoshizumi, Yuji Soejima, Hideaki Uchiyama, Ken Shirabe, Yoshihiko Maehara
BACKGROUND: The use of ABO incompatible (ABOi) graft in living donor liver transplantation (LDLT) has not been an established procedure worldwide. METHODS: Four hundred and eight adult LDLTs, using ABOi (n=19) and non-ABOi (n=389) grafts, were performed as a single center experience. RESULTS: In ABOi-LDLT group (n=19), median isoagglutinin titer before plasma exchange (PE) at LDLT and after LDLT (max) was ×256, ×32 and ×32, respectively...
April 2016: Hepatobiliary Surgery and Nutrition
https://www.readbyqxmd.com/read/26637210/low-dose-of-mycophenolate-mofetil-is-enough-in-desensitized-kidney-transplantation-using-rituximab
#12
Chung Hee Baek, Hyosang Kim, Hoon Yu, Eunhye Shin, Hyungjin Cho, Won Seok Yang, Duck Jong Han, Su-Kil Park
BACKGROUND: Rituximab is widely used in kidney transplantation. However, it is not clear whether the conventional doses of maintenance immunosuppressant in rituximab-treated kidney transplantation (KT) are appropriate. In our previous study, decreasing mycophenolate mofetil (MMF) dose due to infection did not increase the incidence of rejection or graft failure. Based on these experiences, we developed a new protocol with a lower dose of MMF and studied its clinical outcomes in rituximab-treated KT...
December 4, 2015: BMC Nephrology
https://www.readbyqxmd.com/read/26622429/high-dose-immunosuppressant-alters-the-immunological-status-of-new-zealand-white-rabbits-following-skin-transplantation
#13
Peilun Cheng, Liming Zhong, Zesheng Jiang, Yan Wang, Mingxin Pan, Y I Gao
The aim of this study was to investigate the effect of an immunosuppressant on the immunological status of New Zealand white rabbits after skin grafting, and to evaluate a method for monitoring the immunological status of subjects with skin transplants. The rabbits were randomly divided into allograft rejection, autograft tolerance, nontransplant, allograft low-dose immunosuppressant and allograft high-dose immunosuppressant groups. The rabbits in the low- and high-dose immunosuppressant groups were treated with cyclosporine A intravenously 8 h prior to skin transplantation and once daily following transplantation at doses of 2 and 25 mg/kg, respectively...
September 2015: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/26372830/abo-incompatible-adult-living-donor-liver-transplantation-under-the-desensitization-protocol-with-rituximab
#14
G-W Song, S-G Lee, S Hwang, K-H Kim, C-S Ahn, D-B Moon, T-Y Ha, D-H Jung, G-C Park, W-J Kim, M-H Sin, Y-I Yoon, W-H Kang, S-H Kim, E-Y Tak
ABO incompatibility is no longer considered a contraindication for adult living donor liver transplantation (ALDLT) due to various strategies to overcome the ABO blood group barrier. We report the largest single-center experience of ABO-incompatible (ABOi) ALDLT in 235 adult patients. The desensitization protocol included a single dose of rituximab and total plasma exchange. In addition, local graft infusion therapy, cyclophosphamide, or splenectomy was used for a certain time period, but these treatments were eventually discontinued due to adverse events...
January 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/26108258/evaluation-of-blood-group-antibodies-in-abo-incompatible-living-donor-kidney-transplantation
#15
Ken Sugiyama, Yoji Hyodo, Atsushi Aikawa
OBJECTIVE: To assess changes in anti-blood type antibody titers and postoperative outcomes (graft survival and rejection rates) at our center with the use of the immunosuppressant, rituximab, in ABO-incompatible kidney transplants from living donors. Confirming anti-donor blood group antibodies is important for avoiding humoral rejection in ABO-incompatible kidney transplants. Splenectomy has been carried out in our hospital according to Alexandre's policy in order to suppress the production of anti-donor blood group antibodies...
October 2015: International Journal of Urology: Official Journal of the Japanese Urological Association
https://www.readbyqxmd.com/read/25891718/results-of-abo-incompatible-liver-transplantation-using-a-simplified-protocol-at-a-single-institution
#16
J Lee, J G Lee, J J Lee, M S Kim, M K Ju, G H Choi, J S Choi, S I Kim, D J Joo
BACKGROUND: Because of the development of various desensitization strategies, ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has become a feasible option for patients with end-stage liver disease. However, there has been no united desensitization protocol for ABOi LDLT. We analyzed the outcomes after establishment of simplified protocol without splenectomy, intravenous immunoglobulin, and local infusion therapy. METHODS: We analyzed 19 ABOi LDLT cases that had been performed between January 2012 and December 2013, without splenectomy and local infusion...
April 2015: Transplantation Proceedings
https://www.readbyqxmd.com/read/25808777/successful-abo-incompatible-living-related-intestinal-transplantation-a-2-year-follow-up
#17
D M Fan, Q C Zhao, W Z Wang, H Shi, M Wang, D L Chen, J Y Zheng, M B Li, G S Wu
ABO-incompatible intestinal transplantation has rarely been performed due to poor patient outcomes. Herein we present a case of successful ABO-incompatible intestinal transplantation with a 2-year follow-up. A 16-year-old female with a history of extensive bowel resection received an ABO-incompatible living donor bowel graft from her father (blood type AB graft into a type A recipient). Posttransplant immunosuppression consisted of an initial anti-CD20, plasmapheresis/intravenous immunoglobulin before transplantation, followed by an anti-thymocyte globulin (ATG) induction and splenectomy, and maintenance with tacrolimus and prednisone...
May 2015: American Journal of Transplantation
https://www.readbyqxmd.com/read/25449537/kinetics-of-b-t-nk-lymphocytes-and-isoagglutinin-titers-in-abo-incompatible-living-donor-liver-transplantation-using-rituximab-and-basiliximab
#18
Seung Duk Lee, Seong Hoon Kim, Sun-Young Kong, Young-Kyu Kim, Sang-Jae Park
BACKGROUND: The kinetics of isoagglutinin titers and lymphocyte subpopulations including B, T, and natural killer (NK) cells after ABO incompatible (ABO-I) living donor liver transplantation (LDLT) have not been evaluated. METHODS: From January 2012 to July 2013, consecutive ABO-I LDLT patients were enrolled at the National Cancer Center. Our desensitizing protocol included rituximab, plasma exchanges, basiliximab, and intravenous immune globulin without splenectomy...
January 2015: Transplant Immunology
https://www.readbyqxmd.com/read/25389083/abo-incompatible-renal-transplantation-without-antibody-removal-using-conventional-immunosuppression-alone
#19
COMPARATIVE STUDY
R Masterson, P Hughes, R G Walker, C Hogan, M Haeusler, A R Robertson, R Millar, N Suh, S J Cohney
ABO incompatible living donor renal transplantation (ABOi) can achieve outcomes comparable to ABO compatible transplantation (ABOc). However, with the exception of blood group A2 kidneys transplanted into recipients with low titer anti-A antibody, regimens generally include antibody removal, intensified immunosuppression and splenectomy or rituximab. We now report a series of 20 successful renal transplants across a range of blood group incompatibilities using conventional immunosuppression alone in recipients with low baseline anti-blood group antibody (ABGAb) titers...
December 2014: American Journal of Transplantation
https://www.readbyqxmd.com/read/25387763/an-update-on-abo-incompatible-kidney-transplantation
#20
REVIEW
Stefan Zschiedrich, Albrecht Kramer-Zucker, Bernd Jänigen, Maximilian Seidl, Florian Emmerich, Przemyslaw Pisarski, Tobias B Huber
ABO-incompatible kidney transplantation is nowadays a well-established procedure to expand living donor transplantation to blood group incompatible donor/recipient constellations. In the last two decades, transplantation protocols evolved to more specific isohaemagglutinin elimination techniques and established competent antirejection protection protocols without the need of splenectomy. ABOi kidney transplantation associated accommodation despite isohaemagglutinin reappearance, C4d positivity of peritubular capillaries as well as the increased incidence of bleeding complications is currently under intense investigation...
April 2015: Transplant International: Official Journal of the European Society for Organ Transplantation
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