ABO-incompatible kidney transplantation in elderly patients over 60 years of ageReport as inadecuate




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International Urology and Nephrology

, Volume 44, Issue 5, pp 1563–1570

First Online: 25 July 2012Received: 29 February 2012Accepted: 12 June 2012

Abstract

IntroductionPatients aged 60 years and older represent the fastest-growing population with end-stage renal disease worldwide, and the need for a kidney transplant among this population is increasing. Due to the severe shortage of deceased donors in Japan, ABO-incompatible living donor kidney transplantation has been performed since the late 1980s. Excellent long-term outcomes have been achieved, and the rates of graft survival in these patients are currently similar to those in recipients of ABO-compatible grafts. However, the outcomes of ABO-incompatible kidney transplantation in elderly patients over 60 years of age have not been well studied yet.

Patients and methodsWe studied 4 elderly kidney transplant patients who received their grafts from ABO-incompatible living donors at our institution between December 2006 and December 2011, focusing on the immunosuppressive protocols, complications and graft survivals. The mean observation period was 21.5 months range, 8 months to 62 months. Our immunosuppressive protocols were as follows: to remove the anti-A-B antibodies, the patients underwent 4–8 sessions of double-filtration plasmapheresis and-or plasma exchange prior to kidney transplantation until the anti-A-B titers were less than 1:16. For the patients with low anti-A-B titers <1:512, the immunosuppressive protocol consisted of a single dose of rituximab 150 mg-m. The patients with high anti-A-B antibody titers ≥1:512 underwent splenectomy and received 2 doses of rituximab. The pretransplant immunosuppressive protocol included B-lymphocyte suppression with 4 weeks of mycophenolate mofetil 0.5 g-day for low-titer protocol and 1 g-day for high-titer protocol.

ResultsAll 4 patients underwent successful transplantation. At the end of follow-up, their mean serum creatinine was 1.18 mg-dl. No patient experienced antibody-mediated rejection or acute cellular rejection. Late-onset neutropenia occurred in two cases. Two cases experienced cytomegalovirus reactivation by cytomegalovirus antigenemia. In one patient, diffuse hemorrhage required surgical intervention. However, there were no severe complications.

ConclusionsAlthough a careful evaluation of patients is needed, ABO-incompatible kidney transplantation may become a viable treatment option for elderly patients with end-stage renal disease.

KeywordsKidney transplantation ABO-incompatible Elderly patients Desensitization protocol  Download fulltext PDF



Author: Junji Uchida - Tomoaki Iwai - Yuichi Machida - Nobuyuki Kuwabara - Kazuya Kabei - Masaki Murao - Taiyo Otoshi - Toshihide 

Source: https://link.springer.com/







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