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

• Published in: Clinical transplantation and research Vol. 34; no. 2; pp. 121 - 125
• Main Authors: Cho, Jeong Min, Jun, Heungman, Jo, Hyung Ah, Han, Kum Hyun, Kim, Han-Seong, Han, Sang Youb
• Format: Journal Article
• Language: English
• Published: The Korean Society for Transplantation 30-06-2020; Korean Society for Transplantation; 대한이식학회
• Subjects: Case Report; kidney transplantation; abo blood-group system; blood group incompatibility; steroid; withholding treatment; 의학일반
• DOI: 10.4285/kjt.2020.34.2.121
• EISSN: 2671-8804; 3022-7712
• ISSN: 2671-8790; 3022-6783

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/m
2
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.