ABO incompatible high-titer renal transplantation without splenectomy or anti-CD20 treatment

Dorry L. Segev, Christopher E. Simpkins, Daniel S. Warren, Karen E. King, R. Sue Shirey, Warren R. Maley, J. Keith Melancon, Matthew Cooper, Tomasz Kozlowski, Robert A. Montgomery

Research output: Contribution to journalArticlepeer-review

116 Scopus citations


Most successful protocols for renal transplantation across ABO incompatible (ABOi) barriers have utilized splenectomy as part of the pre-conditioning process. We recently described successful ABOi transplantation using anti-CD20 monoclonal antibody in lieu of splenectomy. In the current study, we hypothesized that plasmapheresis (PP) and low dose CMV hyper-immunoglobulin (CMVIg) alone would be sufficient to achieve successful engraftment of ABOi kidneys. We describe four blood type incompatible patients who received live donor renal transplants from A1 (two patients), A2 (one patient), and B (one patient) donors. All patients started with antihuman globulin (AHG) phase titers of 64 or higher and were pre-conditioned with PP/CMVIg but not splenectomy or anti-CD20. All 4 patients underwent successful transplantation and have a mean current serum creatinine of 1.1 (range: 0.9-1.2). There were no episodes of antibody mediated rejection. Rapid allograft accommodation may limit the need for long-term antibody suppression provided by splenectomy or anti-CD20, thereby eliminating the added infectious risk of these modalities and removing another disincentive to ABOi transplantation.

Original languageEnglish (US)
Pages (from-to)2570-2575
Number of pages6
JournalAmerican Journal of Transplantation
Issue number10
StatePublished - Oct 2005


  • B cells
  • Flow cytometry cross-matching
  • Hyperacute rejection
  • IVIG
  • Kidney transplantation
  • Plasmapheresis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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