Living-donor kidney transplant from a type a donor to a type a subgroup recipient

• Published in: Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation Vol. 13; no. 2; pp. 193 - 195
• Main Authors: Ueda, Norichika, Nishimura, Kenji, Yoshida, Yasuyuki, Hirai, Toshiaki, Kishikawa, Hidefumi, Ichikawa, Yasuji
• Format: Journal Article
• Language: English
• Published: Turkey 01.04.2015
• Subjects: ABO Blood-Group System; Aged; Cyclosporine - administration & dosage; Humans; Immunosuppressive Agents - administration & dosage; Kidney Transplantation; Living Donors; Male; Mycophenolic Acid - administration & dosage; Mycophenolic Acid - analogs & derivatives; Prednisolone - administration & dosage; Rituximab - administration & dosage
• ISSN: 2146-8427
• DOI: 10.6002/ect.2013.0247

Type A subgroup is rare in Japan, and kidney transplant to a type A subgroup recipient is rare worldwide. A 65-year-old man presented for living-donor kidney transplant. Blood group testing showed that his wife (kidney donor) had blood group type A. The patient (recipient) had a type A subgroup because reverse blood grouping showed a weak reaction with A1 antigen. Further testing showed that the recipient had type A subgroup between Ax and Ael because adsorption elution experiments and flow cytometry showed a few A antigens that were not detected on forward grouping, and DNA analysis was not consistent with Ael. The patient was given a milder protocol for immunosuppressive preoperative therapy than typically used for ABO-incompatible kidney transplant; mycophenolate mofetil and prednisolone were started 3 weeks and cyclosporine 2 weeks before transplant, rituximab (100 mg) was given once, and double filtration plasmapheresis and plasma exchange were not used. Follow-up at 9 months after transplant showed stable clinical status and no allograft rejection. In summary, the present case showed that when type A subgroup recipient has low level of anti-A1 antibody and is receiving a kidney transplant from a blood type A donor, milder immunosuppressive preoperative therapy appears safe.