ABO-incompatible pediatric kidney transplantation in a single-center trial

We have performed ten pediatric kidney transplantations from living-related ABO-incompatible donors. All patients underwent preoperative plasmapheresi s with or without immunoadsorption to reduce isoagglutinin. Primary immunos uppression consisted of methylprednisolone, cyclosporin or tacrolimus, azat hioprine, anti-lymphocyte globulin, and/or deoxyspergualin. At transplantat ion splenectomy was simultaneously performed in all patients. Median follow -up is 65 months (range 4-95 months). The patient and graft survival rates are 100% to date. Post-transplantation isoagglutinin titers did not increas e more than 1:32, except for 1 patient, without uncontrollable vascular rej ection episodes. Despite the heavy immunosuppressive regimen, cytomegalovir us infection occurred in only three patients, who were successfully treated with ganciclovir and cytomegalovirus high-titer gamma globulin. Our small series clearly shows that the preoperative reduction of isoagglutinin, sple nectomy, and strict immunosuppressive: therapy lead to successful long-term results in children.