Abstract: SA-PO1168
Graft Survival and Patient Outcomes in ABO-Incompatible Kidney Transplant with Baseline High and Low Isohemagglutinin Titers Compared with ABO-Compatible Transplant
Session Information
- Transplantation: Clinical - Rejection, Recurrent Disease, Incompatibility
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Gaur, Lovy, Sir Ganga Ram Hospital, New Delhi, India
- Bhalla, Anil, Sir Ganga Ram Hospital, New Delhi, India
- Rana, Devinder S., Sir Ganga Ram Hospital, New Delhi, India
- Gupta, Ashwani, Sir Ganga Ram Hospital, New Delhi, India
- Malik, Manish, Sir Ganga Ram Hospital and GRIPMER, New Delhi, India
- Gupta, Anurag, Sir Ganga Ram Hospital, New Delhi, India
- Bhargava, Vinant, Sir Ganga Ram Hospital, New Delhi, India
- Shingada, Aakash, Sir Ganga Ram Hospital, New Delhi, India
- Joshi, Anant, Sir Ganga Ram Hospital, New Delhi, India
Background
ABO incompatible kidney transplantation (ABOiKT) helps to increase donor pool.No study till date has compared outcomes in high & low baseline isohemagglutinin titers to that in ABO compatible transplants (ABOcKT).This study attempts to evaluate correlation of baseline anti-A & anti- B isoagglutinin titres on graft survival and patient outcome in ABOiKT as compared to ABOcKT.
Methods
This was a retro-prospective observational study evaluating 954 renal transplant recipients.Of these,873 patients underwent ABOcKT.Of 81 patients who underwent an ABOiKT,67 belonged to low titer group (baseline IgG ≤1:64) and 14 belonged to high titer group(baseline IgG≥1:128).Patients were followed up for 1 year.Graft survival,rejection episodes,patient survival & infections were assessed.
Results
Mean age of patients who underwent ABOcKT, ABOi-high titer group and ABOi-low titer group was 40.47±12.19,38.79±16.21& 40.37±12yrs respectively.Mean donor age was 45.08±10.26,49±11.42 & 45.91±10.15 yrs respectively.Majority of donors were females-68.8%,78.6% & 79.1% respectively.Chronic glomerulonephritis was most common cause of ESRD.HLA mismatches were lower in the ABOcKT group.Death censored graft survival was lower in high titer group (92.3%) compared to ABOcKT group (98.8%), p=0.231.Graft survival in low titer group (96.8%) was comparable to ABOc group(96.8%, p=0.328).Proportion of patients with biopsy proven rejections was lower in ABOcKT groups (6.5%) when compared to ABOi high (21.4%) & low titer groups (13.4%) respectively(p=0.063 and 0.033).Antibody mediated rejections were significantly fewer in ABOcKT group(1.8%) vs high titer(21.4%) & low titer group(11.9%) (p=0.003 and p<0.001).Patient survival was better in ABOcKT group(97.9%) compared to high (92.9%) and low titer (94.0%) groups.Most deaths were attributed to infections.Low titer group fared better than high titer group in having lesser infection episodes, though difference was insignificant(p=0.532).
Conclusion
High baseline isoagglutinin titers are associated with poor graft survival in ABOi grafts compared to ABOc grafts, even though the difference was not significant.High baseline antibody titers are associated with significantly greater number of rejections & infections