ABSTRACT
BACKGROUND: Because of the severe shortage of suitable deceased donors, ABO-incompatible living donor kidney transplantation (ABOi LDKT) is performed even in pediatric recipients in Japan. We performed pediatric ABOi LDKT using rituximab without anti-A/B antibody removal. METHODS: Thirteen pediatric recipients (mean age 7.4, range 3.4-15.7, four females) whose baseline anti-A/B IgG titers were ≤ × 64 underwent ABOi LDKT without antibody removal and splenectomy between July 2013 and April 2017 at Toho University. Mycophenolate mofetil (MMF) was initiated on day - 10. Rituximab (100 mg) was administered twice. Basiliximab and triple maintenance immunosuppression (calcineurin inhibitor, MMF, and steroids) were administered. Protocol biopsy was performed at 3 months and 1 year after transplantation. We retrospectively compared the clinical outcomes between these recipients and 37 children (mean age 9.0, range 2.6-18.9, 15 female) who underwent ABO-compatible (ABOc) LDKT during the same period. RESULTS: The mean follow-up periods of ABOi and ABOc groups were 31.9 ± 13.5 and 28.8 ± 14.4 months, respectively. In the ABOi group, no clinical acute rejection (AR) was noted and subclinical AR was observed in four patients without evidence of acute antibody-mediated rejection. In the ABOc group, clinical and subclinical AR developed in 3 and 10 patients, respectively. No significant difference was identified for the mean eGFR between the ABOi and ABOc groups (98.3 ± 48.8 vs. 86.9 ± 39.4, P = 0.452 at 3 months; 78.2 ± 21.2 vs. 79.7 ± 21.3, at 1 year, P = 0.830). Death-censored graft survival at follow-up was 100% in the ABOi group and 94.6% in the ABOc group. Patient survival during the follow-up period in both the groups was 100%. Late-onset neutropenia (LON) requiring granulocyte colony-stimulating factor occurred more frequently in the ABOi group than in the ABOc group (4 vs. 0 patients) (P < 0.001). CONCLUSIONS: Pre- and post-transplantation antibody removal is not a prerequisite for successful pediatric ABOi LDKT, at least in patients with a low anti-A/B IgG antibody titer. However, LON caused by rituximab should be monitored.
Subject(s)
ABO Blood-Group System/immunology , Blood Group Incompatibility/therapy , Graft Rejection/prevention & control , Immunosuppressive Agents/administration & dosage , Kidney Failure, Chronic/surgery , Kidney Transplantation/adverse effects , Adolescent , Allografts/immunology , Allografts/pathology , Allografts/supply & distribution , Antibodies/immunology , Antibodies/isolation & purification , Biopsy , Blood Group Incompatibility/blood , Child , Child, Preschool , Drug Administration Schedule , Drug Therapy, Combination/methods , Female , Follow-Up Studies , Graft Rejection/blood , Graft Rejection/epidemiology , Graft Rejection/pathology , Graft Survival/drug effects , Graft Survival/immunology , Humans , Immunosuppression Therapy/methods , Japan , Kidney/immunology , Kidney/pathology , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/mortality , Kidney Transplantation/methods , Living Donors , Male , Plasmapheresis , Retrospective Studies , Treatment OutcomeSubject(s)
Glomerulosclerosis, Focal Segmental/diagnosis , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/surgery , Abnormalities, Multiple/diagnosis , Abnormalities, Multiple/therapy , Arteriosclerosis/complications , Arteriosclerosis/diagnosis , Follow-Up Studies , Glomerulosclerosis, Focal Segmental/complications , Glomerulosclerosis, Focal Segmental/surgery , Humans , Immunologic Deficiency Syndromes/complications , Immunologic Deficiency Syndromes/diagnosis , Infant , Kidney Failure, Chronic/complications , Kidney Transplantation , Male , Nephrotic Syndrome/complications , Nephrotic Syndrome/diagnosis , Osteochondrodysplasias/complications , Osteochondrodysplasias/diagnosis , Primary Immunodeficiency Diseases , Pulmonary Embolism/complications , Pulmonary Embolism/diagnosis , Rare Diseases , Risk Assessment , Time Factors , Treatment Outcome , Young AdultABSTRACT
A 6-year-old boy received renal transplantation and was treated with methylprednisolone, cyclosporine A and mizoribine. He developed Epstein-Barr virus-associated malignant lymphoma at 10 years and thyroid papillary carcinoma at 20 years of age. Chemotherapy for the malignant lymphoma was done after withdrawal of cyclosporine A and mizoribine, and thyroidectomy was performed for thyroid carcinoma. He was well and his serum creatinine was 1.0 mg/dl at 22 years of age. To our knowledge, no pediatric renal transplant recipient who had thyroid carcinoma or two different types of tumor has been reported in Japan.
Subject(s)
Kidney Transplantation/adverse effects , Lymphoma/virology , Carcinoma, Papillary/drug therapy , Carcinoma, Papillary/virology , Child , Herpesvirus 4, Human/isolation & purification , Humans , Lymphoma/drug therapy , Male , Thyroid Neoplasms/virology , Thyroidectomy , Young AdultABSTRACT
BACKGROUND: Growth impairment, microcephaly and developmental delay in young children with chronic renal failure improve after successful renal transplantation. There have been few reports on head circumference (HC) and development after transplantation. METHOD: Standard deviation scores (SDS) of height and HC and developmental quotient (DQ) after successful renal transplantation were evaluated in 12 recipients under 5 years of age. At the time of transplantation their mean age was 2.5 years and mean bodyweight was 9.0 kg. RESULTS: Mean height SDS was -3.0 at transplantation and increased to -2.3 at 1 year after transplant (P = 0.002). Mean HC-SDS increased from -1.4 to -0.9 at 1 year after transplant (P = 0.02). As for each category of DQ examined 1 year after transplant, mean scores of gross motor function, basic practice, personal relations, speech and recognition increased from 69 to 90 (P = 0.007), from 77 to 102 (P = 0.02), from 87 to 103 (P = 0.04), from 71 to 90 (P = 0.0006), and from 88 to 101 (P = 0.03), respectively. CONCLUSION: In young children, physical growth, HC growth and DQ scores increased 1 year after transplantation. Dialysis and transplantation program should be planned in young children with end-stage renal failure in anticipation of growth and development of each patient.
Subject(s)
Growth/physiology , Head/anatomy & histology , Kidney Transplantation , Body Height , Child, Preschool , Female , Humans , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/surgery , MaleABSTRACT
Three girls with normal growth hormone secretion had received renal transplantation when aged 2 to 6 years. They had had severely retarded growth (SD for height score was -7.4 to -3.7) at the time of transplantation. After renal transplantation, steroid was withdrawn and they were treated with recombinant human growth hormone; they subsequently reached adult heights of 145 to 156 cm. The SD for adult height score was -2.6 to -0.3. The adult height in two patients was over their target height, calculated using the mean of the parents' height. This report shows the efficacy of steroid withdrawal and recombinant human growth hormone therapy in achieving adult height in these three girls after renal transplantation.
