Korean J Transplant.  2020 Jun;34(2):121-125. 10.4285/kjt.2020.34.2.121.

A case of successful late steroid withdrawal after ABO-incompatible kidney transplantation

• Cho JM
• Jun H
• Jo HA
• Han KH
• Kim HS
• Han SY

• KMID: 2503890
• DOI: http://doi.org/10.4285/kjt.2020.34.2.121

Abstract

Few data exist regarding steroid withdrawal in ABO-incompatible (ABO-i) kidney transplantation (KT). Here, we report a case of steroid withdrawal after ABO-i KT. A 46-year-old man diagnosed with Henoch-Schonlein purpura received ABO-i KT from his 42-year-old sister. The recipient and donor blood types were O and AB, respectively. His preoperative ABO antibody titers were anti-A of 1:16 and anti-B of 1:8 in isoagglutinin test. HLA mismatch was 0 and he received a single 325 mg/m2 dose of intravenous (IV) rituximab 4 weeks before KT. Three sessions of plasma exchange were undertaken before KT and low-dose IV immunoglobulin of 0.1 g/kg was administered after plasma exchange. On the day of the operation, ABO antibody titer decreased to anti-A of 1:4 and anti-B of 1:2. Renal function remained stable after KT. The patient wished to stop steroid treatment despite the risk of rejection after withdrawal. Steroid tapering was initiated at 20 months and accomplished at 26 months after KT. At that time, serum creatinine level was 1.13 mg/dL, and anti-A and anti-B titers were 1:8 and 1:2, respectively. No issues were observed after steroid withdrawal. At 48 months after KT, serum creatinine level was 1.21 mg/dL, and anti-A and anti-B antibody titers were 1:32 and 1:2, respectively. Steroid withdrawal in ABO-i KT might be considered in immunologically low-risk patients.

Keyword

Kidney transplantation; ABO blood-group system; Blood group incompatibility; Steroid; Withholding treatment

Figure

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  Fig. 1 Transplanted kidney biopsy. (A) Periodic Acid Schiff stain, ×100. (B) Electron microscopy, ×2,500. Kidney biopsy showed nonspecific changes. No electron dense deposits were noted in ultrastructural examination. The glomerular basement membrane was normal in thickness with smooth inner and outer contours. Epithelial foot processes were intact. No multilayering was noted in peritubular capillary basement membrane.

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