ABO-incompatible living donor kidney transplantation: report of 14 cases

Abstract

Objective To investigate the clinical efficacy and safety of ABO-incompatible living donor kidney transplantation. Methods A series of 14 living donor kidney transplants across a range of ABO blood group incompatibilities using individualized preconditioning protocols to reduce ABO antibodies were obtained in West China Hospital, Sichuan University. ABO blood group incompatibilities were B to O (3), B to A (1), AB to B (1), AB to A (4), A to O (4), A to B (1). Preconditioning included oral immunosuppressants with/without the administration of rituximab, plasma exchange or double filtration plasmapheresis. Medical records and electronic databases were reviewed for isoagglutinin titers, patient and graft survival, graft function, rate of rejections, infections as well as for surgical complications. Results After individualized preconditioning, an acceptable isoagglutinin titer (≤1∶16) was obtained on the date of transplantation, and no recipients of isoagglutinin titers rebounded (>1∶16) within two weeks after transplantation. In total, there was one episode of hyperacute rejection (leading to graft loss), acute antibody-mediated rejection, acute cellular-mediated rejection, acute tubular necrosis and urinary tract infection, and two episodes of wound fat liquefaction, bone marrow suppression and pneumonia, respectively, in the perioperative period. No recipients experienced blood coagulation disorders (bleeding tendency/thrombosis) perioperatively. Median follow-up duration was 7 months (2-18.5); graft and patient survival rate was 92.9% and 100% respectively; median value of serum creatinine was 92 mol/L (56-652 mol/L). Conclusion Our initial experience indicates that individualized preconditioning protocols to reduce ABO antibodies based on initial titers is technically feasible and leads to excellent short-term survival of ABO-incompatible living donor kidney transplantation. Key words: Kidney transplantation; Living donor; ABO Blood-Group; Incompatible