Plasmapheresis, CMV hyperimmune globulin, and anti-CD20 allow ABO-incompatible renal transplantation without splenectomy

Christopher J. Sonnenday, Daniel S. Warren, Mathew Cooper, Milagros Samaniego, Mark Haas, Karen E. King, R. Sue Shirey, Christopher E. Simpkins, Robert A. Montgomery

Research output: Contribution to journalArticlepeer-review

233 Scopus citations


The majority of preconditioning protocols developed to allow ABO-incompatible (ABOi) renal transplantation include concurrent splenectomy as a prerequisite to successful engraftment. Our center has developed a preconditioning protocol that includes plasmapheresis (PP), low-dose CMV hyperimmune globulin (CMVIg), and anti-CD20 monoclonal antibody (rituximab) to allow ABOi renal transplantation without splenectomy. Our initial experience has included treatment of six recipients and successful transplantation from blood group A1, A2, and group B living donors. Mean (± SD) serum creatinine was 1.3 ± 0.1 mg/dL among the six recipients and no episodes of antibody-mediated rejection (AMR) occurred at a median follow-up of 12 months. ABO antibody titers have remained below pretreatment levels. The absence of AMR and stable allograft function in this series show the potential of this preconditioning protocol to increase ABOi renal transplantation. The use of rituximab, allowing avoidance of splenectomy, may further remove one of the significant disincentives to ABOi transplantation, and eliminate the risk of post-splenectomy infections.

Original languageEnglish (US)
Pages (from-to)1315-1322
Number of pages8
JournalAmerican Journal of Transplantation
Issue number8
StatePublished - Aug 2004


  • ABO-incompatible
  • Desensitization
  • Renal transplantation
  • Rituximab

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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