ABO-INCOMPATIBLE KIDNEY-TRANSPLANTATION IN CHILDREN

We have performed 7 pediatric kidney transplantations from living rela ted donors of ABO incompatibility. All patients preoperatively underwe nt plasmapheresis with or without immunoadsorption to reduce anti-A an d/or anti-B antibodies. Immunosuppression initially consisted of methy lprednisolone, cyclosporine, azathioprine, antilymphocyte globulin and deoxyspergualin. At transplantation splenectomy was simultaneously pe rformed in all patients, Median followup is 44 months (range 31 to 58) . Patient and graft survival rates are 100% to date. There were no unc ontrollable vascular rejection episodes, and post-transplant anti-A an d/or anti-B antibody titers were always less than 1:32. Transplantatio n across the ABO blood barrier remains challenging today. However, our small series clearly shows that the preoperative reduction of ABO ant ibody, simultaneous splenectomy and strict immunosuppressive therapy c ause successful long-term results in children.