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Abstract: FR-PO889

ABO Incompatible Kidney Transplantation Without Use of Anti-CD20 Antibody or Splenectomy: Experience from Northern India

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Sharma, Amit, FORTIS HOSPITAL MOHALI, MOHALI, PUNJAB, India
  • Gill, Harinder Jit Singh, FORTIS HOSPITAL MOHALI, MOHALI, PUNJAB, India
Background

ABO-incompatible (ABOi) renal transplants help in crossing an important immunological barrier against kidney transplantation, thereby meeting the unmet demands of renal transplants. The study was conducted to assess ABOi transplant without the use of Anti CD20 antibody or splenectomy and compare their outcomes with ABO compatible (ABOc) transplants.

Methods

The study period was from January 2014 to February 2018. 290 patients were divided into two groups: ABOi (n=33) or ABOc (n=257) living renal donors. In ABOi cases, plasmapheresis and low dose intravenous immunoglobulin (100 mg/kg) was given till isoagglutinin titer were <1:8. All patients received induction immunosuppression: Thymoglobulin (1 mg/kg/day for 3 days) for all ABOi and ABOc with HLA mismatch > 3/6 and Basiliximab in ABOc with HLA mismatch < 3/6. In ABOi, titers were monitored post-operatively and plasmapheresis was done if they increased to >1:8 in first week and >1:16 in second and third week post transplant. Patient and allograft survival; 1, 3, 6, 12, 24, and 36-month renal function; infectious complications; and incidence of rejection were measured.

Results

30.3% of the ABOi recipients and 22.17% of ABOc recipients were females. Median isoagglutinin titer at start was 1:32 (1:1 to 1:256). Mean number of plasmapheresis required were 3. In ABOi group, Mean±SD creatinine levels were 1.37±0.41 mg/dL at 1 month, 1.29±0.31 mg/dL at 12 months, and 1.36±0.39 mg/dL at 36 months. In ABOc group, Mean±SD creatinine levels were 1.26±0.41 mg/dL at 1 month, 1.26±0.44 mg/dL at 12 months, and 1.28±0.45 mg/dL at 36 months. In the ABOi group, there were 6 episodes of acute antibody mediated rejection (AMR) and 1 patient had acute cellular rejection (ACR), which were successfully treated (3 AMR and 4 ACR were observed in the ABOc group). Two patients succumbed to fungal sepsis in the ABOi group.

Conclusion

Successful ABOi renal transplantation is possible without the use of splenectomy or Anti-CD20 treatment but AMR episodes as well as fungal sepsis are significantly high.