a, c Hematoxylin and eosin (H.E) staining ?400, (b): Periodic acid-Schiff (PAS) ?400). showed evidence of T-cell-mediated rejection IB. The patient was treated with steroids, Rbin-1 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 Rbin-1 for improving mortality and quality of life [1]. However, while the number of patients waiting for a donor Rbin-1 kidney is increasing, there is a shortage of organ transplantation donors [2]. One strategy to address this problem is ABO-incompatible living related kidney transplantation (ABO-iLKT). ABO-iLKT has the potential to expand the opportunities 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 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 similar 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 mismatch in 6 antigens. Initial flow cytometric crossmatch testing (FCXM) was negative. Moreover, the flow cytometric panel reactive antibody (Flow PRA) screening test was negative for human leukocyte antigen (HLA) class I and class II. Single antigen testing was also negative. Three months prior to surgery, 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 Goat polyclonal to IgG (H+L)(Biotin) was 1428?mg/dl. The high titer state following plasmapheresis was considered refractory rebound, and the planned transplant was postponed in order to resume desensitization therapy (MMF 750?mg/day). Four months following the initial start of desensitization therapy.
