HLA Antibody-Incompatible Kidney Transplantation Between Jehovah's Witnesses: A Case Report

A. Greenberg, I. MacPhee, J. Popoola, D. Sage, R. Iqbal, N. Fossati, S. Heap, M. Morsy, Nicos Kessaris

    Research output: Contribution to journalArticlepeer-review

    2 Citations (Scopus)

    Abstract

    Desensitization before HLA antibody-incompatible (HLAi) transplantation involves nonspecific apheresis of HLA antibodies. Clotting factors and albumin are also removed and have to be replaced. This makes transplantation difficult because it increases the risk of bleeding. Such risk is further compounded when certain blood products are refused on religious grounds. We present a case of successful HLAi transplantation in a Jehovah's Witness across a positive-flow cytometric HLA crossmatch from a live donor who was also a Jehovah's Witness. This was achieved by giving rituximab 1 month before transplantation and starting prednisolone, tacrolimus, and mycophenolate mofetil 10 days before surgery. In preparation, the patient also underwent 4 sessions of double-filtration plasma exchange each followed by low-dose intravenous immunoglobulin. The night before transplantation, the fibrinogen was low, requiring 2 pools of cryoprecipitate. The organ was retrieved through laparoscopic hand-assisted retroperitoneoscopic nephrectomy and transplanted into the recipient with no complications. In addition, the patient received basiliximab during surgery. Sixteen months after transplantation the serum creatinine was 70 mu mol/L (0.79 mg/dL) and there were no rejection episodes. To our knowledge this is the world's first live-related kidney transplant across the HLAi barrier between 2 Jehovah's Witnesses. This case may allow further HLAi transplants to be carried out in Jehovah's Witnesses in the future around the world.

    Original languageEnglish
    Pages (from-to)2069-2071
    Number of pages3
    JournalTransplantation Proceedings
    Volume45
    Issue number5
    DOIs
    Publication statusPublished - Jun 2013
    EventBerlin Symposium on Xenotransplantation / 24th International Congress of the Transplantation-Society (TTS) - Berlin, Germany
    Duration: 13 Jul 201219 Jul 2012

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