ABO Incompatible Renal Transplantation Without Protocol Post Transplant TPE: Preliminary Results of a Pilot Study.

Abstract

Background: ABOi renal transplantation is an increasingly practiced method of expanding the kidney donor pool but there is little analysis of the protocols used. Although there is substantial variation in the desensitization regimes, most incorporate protocol post transplant ABO antibody removal with therapeutic plasma exchange (TPE). We recently established an ABOi renal transplant desensitization regime without protocol post transplant TPE and report here the preliminary results. Methods: 8 patients entered into our ABOi program between January 2012 and December 2013. Data were analyzed to determine the number of TPE to achieve target pre transplant ABO antibody titres of < 1:16, ABO antibody titres post transplant, graft survival, graft function and rejection rate. Results: Median baseline ABO titres was 1:128 and all patients achieved target pre transplant ABO titres of < 1:16 after a median of 4 exchanges. Median follow up was 13 months with all patients maintaining ABO titres of < 1:16 at follow up with no protocol post transplant TPE. There was 1 case (12.5%) of acute cellular rejection which was reversed with steroids but none had antibody mediated rejection. Graft survival was 100% with current median serum creatinine 92umol/L.Table: No Caption available.Conclusions: Our preliminary results of 8 consecutive patients suggest that protocol post transplant TPE may not be necessary for maintaining suppression of ABO antibody titres especially in the critical immediate post transplant period. In addition to reducing the cost of ABOi transplants, the risk of overimmunosuppression is also reduced if protocol post ABOi transplant TPE can be avoided.