Korean J Transplant 2020; 34(2): 121-125
Published online June 30, 2020
https://doi.org/10.4285/kjt.2020.34.2.121
© The Korean Society for Transplantation
Jeong Min Cho1 , Heungman Jun2
, Hyung Ah Jo1
, Kum Hyun Han1
, Han-Seong Kim3
, Sang Youb Han1
1Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
2Department of Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
3Department of Pathology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
Correspondence to: Sang Youb Han
Department of Internal Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Korea
Tel: +82-31-910-7201
Fax: +82-31-910-7219
E-mail: hansy@paik.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords: Kidney transplantation, ABO blood-group system, Blood group incompatibility, Steroid, Withholding treatment
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