ABSTRACT
Background: The standard pre- and post-dilution methods of fluid substitution in on-line hemodiafiltration (OL-HDF) have limitations in removal of uremic toxins. Objective: To review the technique and efficiency outcomes of mid-dilution OL-HDF. Results: Mid-dilution OL-HDF could provide comparable or better efficiency with pre- and post-dilution modes. There are no serious adverse effects or technical complications. Conclusion: It appears that mid-dilution OL-HDF could combine the advantages and overcome the disadvantages of pre- and post-dilution modes.
ABSTRACT
Background: Transplantation among ABO blood group incompatibility was considered an absolute contraindication until recent development of successful protocols. A living-donor across ABO barriers may provide another option for end-stage kidney disease patients. Objective: To report the first case of ABO-incompatible living-donor kidney transplantation (ABOi-LKT) in Thailand. Patients and method: The kidney transplantation across ABO barriers was performed following the Japanese recommended protocol. The kidney recipient was a thirty-four years old woman with blood group-O, whereas the kidney donor was her brother with blood group A. To reduce anti-donor (anti-blood group-A antibody) blood levels, the patient underwent double filtration plasmapheresis and received an intravenous anti-CD20 monoclonal antibody. A maintenance immunosuppressive regimen was similar to the one of ABO-compatible setting. Results: The kidney allograft had immediate good function. The transplantation was uneventful, and the patient went home within two weeks. Kidney allograft biopsies were performed on a protocol-driven basis at time-zero, the first and sixth month post-transplantation. Histologic studies showed unremarkable findings. The patient is now twelve months after transplantation and has achieved excellent kidney function. Conclusion: ABOi-LKT provides an alternative treatment for end-stage kidney disease patients. A multi-center study of ABOi-LKT in Thailand is ongoing, and this may change the national policy of organ donation in the near future.