Blog entry by Arif Khwaja

Anyone in the world

The shortage of cadaveric and live donors has lead to increasing interest in ABOi transplantation. Much of this work has been pioneered in Japan where restrictions on cadaveric donation has necessitated the use of ABOi transplantation. Often aggressive immunosuppressant regimes were used including splenectomy coupled with use a rituximab. A report from Melbourne, Australia in this months AJT highlights how ABOi transplantation may now be moving to the mainstream. The Melbourne group report on 37 consecutive ABOi transplants who were followed up for more than 2 years. The immunosuppressive protocol was identical to the non ABOi transplants using Basiliximab, MMF, Prednisolone and Tacrolimus. ABOi transplants underwent plasma exchange pre-operatively and post-operatively to maintain low levels of ABO antibody. IVIG was given post-plasma exchange. There was no significant difference in any outcome between the ABOi and ABO compatible transplants. There was 100% graft survival in both groups and rejection rates were 14% & 17% respectively. Two patients in the ABOi group had antibody-mediated rejection which was treated by plasma exchange in one and required splenectomy in the second patients. The paper demonstrates that ABOi is deliverable and offers an exciting, practical approach to dealing with shortage of donors. As the authors point out an essential part of an ABOi program is to have excellent laboratory support to allow for frequent monitoring of ABO antibodies and quantification of antibody titre.  Usually after the first month post-transplantation a rise in ABO antibody titres does not cause graft damage - a process known as accommodation - the underlying mechanism being unclear. The abstract can be found here http://www.ncbi.nlm.nih.gov/pubmed/21449947

[ Modified: Thursday, 1 January 1970, 1:00 AM ]