ABO-Incompatible Renal Transplantation with High Antibody Titer: A Case Report

Abstract

Patient: Male, 33Final Diagnosis: ABO-incompatible kidney transplantation with high antibody titerSymptoms: Symptoms of end stage real diseaseMedication: —Clinical Procedure:—Specialty: TransplantologyObjective:Management of emergency careBackground:Even though renal transplantation across blood groups is not uncommonly practiced nowadays, there is still hesitation regarding ABO-incompatible transplantation with very high baseline antibody titer. In this case report, the outcome of an ABO-incompatible kidney transplant recipient with a high baseline isoagglutinin titer is reported.Case Report:The patient was a non-diabetic, 33-year-old man with end-stage renal disease secondary to chronic glomerulonephritis. The only kidney donor available was his mother, who was blood-group incompatible. The patient’s blood group was O positive, whereas his mother was B positive. We evaluated him for an ABO-incompatible renal transplant. The baseline anti-B isoagglutinin titer was >1: 8196. With a desensitization protocol of low-dose Rituximab, plasmapheresis, and IVIG, this titer was brought down to 1: 32 before transplantation. He successfully underwent renal transplantation across the ABO barrier, and maintains good graft function after 1 year of follow-up.Conclusions:In the present era, a high baseline isoagglutinin titer is no longer a contraindication for successful kidney transplantation in ABO-incompatible recipient-donor pairs.

Challenges in antibody titration for ABO‐incompatible renal transplantation

“…Due to the location of the RCPAQAP in Australia, most of the laboratories enrolled in the transfusion programs were from Australasia. A total of 24 laboratories from six countries (Australia (16), New Zealand (2), Malaysia (3), Singapore (1), Oman (1) and United Kingdom (1)) returned results for the pilot study. The number of participating laboratories was small because renal transplantation is a highly specialized area.…”

“…There are reports in the literature of successful transplantation in the presence of high antibody titres [16] and reports of accommodation in some ABOi renal transplants [17]. An accommodation phenomenon occurs when the graft organ was not rejected in spite of the presence of recipient antibodies against the antigens on the donated kidney [18].…”

A Multicenter Retrospective Cohort Study on Management Protocols and Clinical Outcomes After ABO-incompatible Kidney Transplantation in India

“…These issues are relevant in emerging countries, such as India, where infections are the primary cause of death. Strikingly, all major reports, including national studies of ABOiKT, have originated from the developed world [16][17][18][19][20][21][22][23][24][25][26] with only a few small case series from India [27][28][29][30][31][32][33][34][35][36] and the developing world. [37][38][39] Here, we present a multicenter study aimed at assessing desensitization protocols, complications, and outcomes of ABOiKT that shares details on the approach and potential of ABOiKT, including plausible future modifications when applied in emerging countries.…”

“…These issues are relevant in emerging countries, such as India, where infections are the primary cause of death. Strikingly, all major reports, including national studies of ABOiKT, have originated from the developed world 16-26 with only a few small case series from India 27-36 and the developing world. 37-39…”