Year: 2005
Type: article
Abstract: To the Editor: The Letter to the Editor from Mitsuhata and colleagues raises some interesting points with regard to the use of anti‐CD20 among patients receiving blood type incompatible allografts. We would agree that the optimal dose and schedule of administration of anti‐CD20 has not been established for transplant patients, and lower dosage regimens should be considered. With a single dose of 375 mg/m2 we have not observed life‐threatening neutropenia, and the median follow‐up period of our original cohort of six recipients now exceeds 24 months. Given the diverse pharmacopeia that these patients are exposed to, including multiple myelosuppressive drugs, it would be very difficult to pinpoint the etiology of neutropenia if it were to occur. With regard to the need for splenectomy, given equal results, it is hard to support an argument that splenectomy has any advantage over anti‐CD20, particularly given the well‐documented risks of post‐splenectomy sepsis detailed in our discussion. We have not observed severe humoral rejection among the cohort of 34 patients that we have transplanted across a blood group barrier and thus have evolved towards using less B‐cell ablative therapy among our patients. Our current practice for patients who have A1 donors and pretreatment anti‐A titers ≤128 by AHG is to avoid the use of either splenectomy or anti‐CD20 (1Segev DL Simpkins CE Warren DS et al.ABO ncompatible igh‐titer renal transplantation without splenectomy or anti‐CD20 treatment.Am J Transplant. 2005; 5: 2570-2575Abstract Full Text Full Text PDF PubMed Scopus (121) Google Scholar). These patients receive peri‐operative plasmapheresis and low‐dose (100 mg/kg) CMVIg with sequential quadruple immunosuppression consisting of induction with an anti‐IL‐2 receptor antibody and maintenance therapy including FK 506, MMF and steroids. Anti‐CD20 and splenectomy are reserved for patients with high anti‐A titers or patients who also have a positive crossmatch with their donor (2Warren DS Zachary AA Sonnenday CJ et al.Successful renal transplantation across simultaneous ABO incompatible and positive crossmatch barriers.Am J Transplant. 2004; 4: 561-568Abstract Full Text Full Text PDF PubMed Scopus (130) Google Scholar).
Authors: C. Sonnenday, D. Warren, R. Montgomery
Institution: Johns Hopkins University
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
OpenAlex ID: W1491831094