SUN-349 PLASMA EXCHANGE THERAPY IN SENSITIZED KIDNEY TRANSPLANT RECEPIENT IN MONGOLIA

Abstract

The Mongolian organ transplant program started in 1996. The first kidney transplantation in Mongolia was performed in 2006, liver transplantation in 2011, first pediatric liver transplantation in 2014, bone marrow transplantation in 2014, first ABO incompitable liver transplantation sucsessfull in 2019. Current number of organ transplantation in Mongolia: LDKTx 184, DDKTx18, LDLTx 79, DDLT3, BMT 16. Kidney transplantation is the treatment of choice for patients with end stage kidney disease as it is associated with improved patient survival, and better quality of life. HLA sensitization, resulting from previous pregnancies, blood product transfusions, or previous transplant, and ABO incompatibility pose significant immunologic barriers to kidney transplantation. HLA sensitized patients present problems as they express multiple alloantibodies due to the presence of donor-specific antibodies (DSAs). Patients transplanted across these barriers without sufficient desensitization are at high risk for early graft loss from antibody mediated rejection (ABMR). However, those that survive still are at a much higher risk of chronic antibody mediated rejection post transplantation with decreased overall allograft survival. Approximately 30% of patients on the kidney transplant waitlist in the US are sensitized against HLA antigens which reduces the opportunities for successful transplantation. Desensitization protocols emerged in the late 1990s but in Mongolia started in 2016. Therapeutic plasma exchange (PE) with combination drug therapy is the mainstay of the antibody reduction therapy. In this retrospective study, we sought to explore the outcomes of plasma exchange in high sensitized renal transplant patients in Mongolia. We investigated eight patients: two patient highly sensitised pre kidney transplant, three patient post kidney transplant with acute antibody mediated rejection, two patient post kidney transplant with de novo DSA and one patient on the deceased donor waiting list who received PE therapy between 2016 and 2019. PE was performed using a Fresenius AS. Indications for therapy, biopsy findings, number of PE sessions, laboratory data, medications, complications as well as graft and patient survivals were recorded. Overall mean age of subjects was 34.1 ± 8.8 years and 1 patient were female and 7 patients were men. All patients underwent 29 plasma exchange sessions. Responses to therapy were 2/3 for acute antibody mediated rejection, 2/2 for high sensitised pre kidney transplant, and 2/2 for de novo DSA and 1/0 for highly PRA for patient on the deceased donor waiting list. No complication was observed in any patient. PE is a safe and successful method for treatment of acute antibody rejection as less so for highly sensitized patients in Mongolia. The outcomes among subjects with high PRA were not satisfactory.