PMID- 15023148
OWN - NLM
STAT- MEDLINE
DCOM- 20041109
LR  - 20230124
IS  - 1600-6135 (Print)
IS  - 1600-6135 (Linking)
VI  - 4
IP  - 4
DP  - 2004 Apr
TI  - Successful renal transplantation across simultaneous ABO incompatible and 
      positive crossmatch barriers.
PG  - 561-8
AB  - ABO incompatibility and human leukocyte antigen (HLA) sensitization remain the 
      two largest barriers to optimal utilization of kidneys from live donors. Here we 
      describe the first successful transplantation of patients who were both ABO 
      incompatible and crossmatch positive with their only available donor. A 
      preconditioning regimen of plasmapheresis (PP) and low-dose CMV hyperimmune 
      globulin (CMVIg) was delivered every other day until donor-specific antibody 
      (DSA) titers were reduced to a safe level and isoagglutinin titers were < or =16. 
      Each patient received quadruple sequential immunosuppression, splenectomy and 
      three protocol post-transplant PP/CMVIg treatments. There was no hyperacute 
      rejection. Two of the three patients had a persistent positive cytotoxic 
      crossmatch on the day of transplant and eliminated their DSA subsequently. 
      Antibody-mediated rejection (AMR) in one patient was reversed by reinitiating 
      PP/CMVIg and anti-CD20. The patients are more than 9 months post-transplant with 
      excellent graft function. Preconditioning with PP/CMVIg results in a durable 
      suppression of DSA and permits accommodation of the allograft to a discordant 
      blood type. The ability to cross these two barriers simultaneously is clinically 
      important as sensitized patients have often exhausted their blood type compatible 
      living donors during previous transplants.
FAU - Warren, Daniel S
AU  - Warren DS
AD  - The Department of Surgery, The Johns Hopkins University School of Medicine, 
      Balitmore, Maryland, USA.
FAU - Zachary, Andrea A
AU  - Zachary AA
FAU - Sonnenday, Christopher J
AU  - Sonnenday CJ
FAU - King, Karen E
AU  - King KE
FAU - Cooper, Matthew
AU  - Cooper M
FAU - Ratner, Lloyd E
AU  - Ratner LE
FAU - Shirey, R Sue
AU  - Shirey RS
FAU - Haas, Mark
AU  - Haas M
FAU - Leffell, Mary S
AU  - Leffell MS
FAU - Montgomery, Robert A
AU  - Montgomery RA
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am J Transplant
JT  - American journal of transplantation : official journal of the American Society of 
      Transplantation and the American Society of Transplant Surgeons
JID - 100968638
RN  - 0 (ABO Blood-Group System)
RN  - 0 (Antibodies)
RN  - 0 (Antigens, CD20)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - *ABO Blood-Group System
MH  - Adult
MH  - Antibodies/chemistry
MH  - Antigens, CD20/chemistry
MH  - Blood Group Incompatibility
MH  - Blood Grouping and Crossmatching
MH  - Female
MH  - Graft Survival
MH  - Histocompatibility Testing
MH  - Humans
MH  - Immunoglobulins, Intravenous/therapeutic use
MH  - Immunohistochemistry
MH  - Immunosuppressive Agents/therapeutic use
MH  - Kidney/pathology
MH  - Kidney Failure, Chronic/therapy
MH  - Kidney Transplantation/*methods
MH  - Kinetics
MH  - Living Donors
MH  - Plasmapheresis/methods
MH  - Time Factors
EDAT- 2004/03/17 05:00
MHDA- 2004/11/13 09:00
CRDT- 2004/03/17 05:00
PHST- 2004/03/17 05:00 [pubmed]
PHST- 2004/11/13 09:00 [medline]
PHST- 2004/03/17 05:00 [entrez]
AID - S1600-6135(22)07479-2 [pii]
AID - 10.1111/j.1600-6143.2004.00364.x [doi]
PST - ppublish
SO  - Am J Transplant. 2004 Apr;4(4):561-8. doi: 10.1111/j.1600-6143.2004.00364.x.