ABO incompatible renal transplants: Good or bad?

Muramatsu, Masaki; González, Héctor Daniel; Cacciola, Roberto; Aikawa, Atsushi; Yaqoob, Magdi; Puliatti, Carmelo

doi:10.5500/wjt.v4.i1.18

Cited by 49 publications

(46 citation statements)

References 94 publications

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“…However, ABO-incompatible (ABOi) renal transplantation has become more popular and hundreds of patients have been successfully transplanted across the ABO-barrier [32][33][34]. Infants have low levels of ABO-antibodies and are immunologically good candidates for ABOi-transplantation.…”

Section: Donor Characteristicsmentioning

confidence: 99%

Renal transplantation in infants

2015

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Renal transplantation (RTx) has become an accepted mode of therapy in infants with severe renal failure. The major indications are structural abnormalities of the urinary tract, congenital nephrotic syndrome, polycystic diseases, and neonatal kidney injury. Assessment of these infants needs expertise and time as well as active treatment before RTx to ensure optimal growth and development, and to avoid complications that could lead to permanent neurological defects. RTx can be performed already in infants weighing around 5 kg, but most operations occur in infants with a weight of 10 kg or more. Perioperative management focuses on adequate perfusion of the allograft and avoidance of thrombotic and other surgical complications. Important long-term issues include rejections, infections, graft function, growth, bone health, metabolic problems, neurocognitive development, adherence to medication, pubertal maturation, and quality of life. The overall outcome of infant RTx has dramatically improved, with long-term patient and graft survivals of over 90 and 80 %, respectively.

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Section: Donor Characteristicsmentioning

confidence: 99%

Renal transplantation in infants

2015

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“…There are four blood groups (A, B, AB and O), with the correlative antibodies (anti-A and/or anti-B), which are known as isohemagglutinins (21). in its sera (19,(22)(23)(24). Both groups A and B are codominantly genetically inherited.…”

Section: Introductionmentioning

confidence: 99%

“…A1 is more immunogenic than A2 (25,26). Patients that are bloodgroup AB have no serum antibodies to blood-groups A or B (22).…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes after ABO-incompatible kidney transplantation; a single-center French study

Abdulrahman¹,

Naciri²,

Allal³

et al. 2017

J Nephropathol

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Background: ABO-incompatible (ABOi) is as efficient as ABO-compatible (ABOc) kidneytransplantation in the setting of live-donation. Objectives: To evaluate the long-term outcomes (i.e. >6 months) of 44 consecutive ABOi living-donor kidney-transplants (KTx). The results were compared to those from 44 ABOc KTx that were matched with ABOi-patients on age, gender, and date of transplantation. Patients and Methods: With regards to immunosuppression (IS) only ABOi-patients received pre-transplant IS, that included rituximab. Induction therapy relied significantly more frequently on basiliximab in ABOc-than in ABOi-patients 77.2% vs. 38.6% (P = 0.0002). Post-transplant IS relied only on tacrolimus/mycophenolic acid and steroids in ABOipatients, whereas some ABOc-patients were alternatively on cyclosporine (13.6%)/ everolimus (11.3%) and no steroids (7%), respectively (P = 0.05). Results: In ABOi-patients there was no isoagglutinin titer rebound posttransplant. At last follow-up patient and graft survival was similar in the two groups, as well as kidneyallograft function. Acute rejection rates (cellular, humoral, or mixed) were similar across both groups (ABOi: 22.7%; ABOc: 20.4%). With regards to bacterial and viral infections the only significant difference between the two groups was that at month three there were significantly more BKV viruria in ABOi (25%) vs. 6.8% in ABOc (P = 0.03). De novo donor-specific alloantibody were detected in 13.6% ABOi and 4.5% ABOc patients (ns). Readmission rates in our department for less than two days were more frequent for ABOi conversely readmission rates for more than two days was similar across the groups. Conclusions: ABOi-kidney transplantation after desensitization provides in the long-term same results as those observed in live-donor ABOc-kidney transplantation.

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“…Los estudios revelan que la tasa de sobrevida de injertos de Tx renal ABO compati ble (ABOc) y ABOi a 5 años son equivalentes (5,(11)(12)(13) . La conti nua inhabilitación de potenciales donantes vivos ABOi consti tuye preocupación en nuestro medio; un tercio de potenciales DV son descartados por presentar grupo sanguíneo incompati ble (14,15) . En este estudio reportamos el caso de un paciente que recibió un retrasplante renal exitoso de donante con alto grado de compati bilidad HLA, pero con incompati bilidad de grupo sanguíneo ABO, de otra manera improbable el trasplante dada su condición de altamente sensibilizado.…”

Section: Introductionunclassified

Trasplante renal grupo sanguíneo ABO incompatible. Experiencia colaborativa inédita España y Perú

et al. 2017

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Resumen La incompatibilidad de grupo sanguíneo ABO y la sensibilización al HLA constituyen grandes barreras a vencer en pro de la óptima utilización de riñones de donante vivo. Describimos en nuestro medio el primer trasplante renal exitoso ABO incompatible en un paciente de 24 años, retrasplantado renal, altamente sensibilizado (PRA: 89%) y sin opción alguna en disponer de donantes cadavéricos ni familiares. Sin embargo, su único donante vivo HLA compatible era de grupo sanguíneo A incompatible con el grupo O del receptor. El paciente requirió de un régimen precondicionante consistente en recambios plasmáticos, rituximab, imunoglobulina y terapia inmunosupresora cuádruple, a fin de reducir los títulos elevados de isoaglutininas anti A de 1:128 a niveles de seguridad de 1:8, para el éxito del trasplante. Este fue realizado en Coordinación con la Unidad de Trasplante Renal del Hospital Clínic de Barcelona España (HCB). La ausencia de rechazo mediado por isoaglutininas muestra el potencial beneficio del protocolo al remover los anticuerpos anti grupo sanguíneo. A los dos años del trasplante, la función renal se mantiene estable con niveles de creatinina 1,5 mg%. Concluimos que el trasplante renal ABO incompatible (ABOi) es opción viable para pacientes cuyo único donante sea grupo sanguíneo incompatible, y entre nosotros representa esperanzadora fuente de órganos. Palabras clave: ABO Incompatible; Trasplante Renal; Acomodación; Anticuerpos anti HLA; Riesgo Inmunológico. Abstract ABO blood group incompatibility and HLA sensitization are major barriers that need to be overcome in order to make optimum use of kidneys from living donors possible. We report the first successful ABOincompatible kidney transplant in a 24-year old, highly sensitized (panel reactive antibodies (PRA) 89% kidney retransplantation patient, who lacked any option to get a cadaveric or family donor. However, the patient's sole HLA-compatible living donor had group A blood incompatible with the recipient's O blood group. The patient required a pre-conditioning regime that consisted of plasma exchange, rituximab, immunoglobulin, and quadruple immunosuppressive therapy in order to reduce high titers of anti-A isoagglutinins from 1:128 to a safe level of 1:8, for successful transplant. This was performed in coordination with the Renal Transplant Unit of Hospital Clinic de Barcelona (HCB), Spain. Absence of rejection mediated by isoagglutinins shows the potential benefit of a protocol consisting in removing antibodies from the anti-blood group. Two years after transplantation, the kidney function remains stable, with creatinine levels of 1.5 mg%. We conclude that an ABO-incompatible kidney transplant is a viable option for patients whose only donor has blood of an incompatible blood group and for us this represents a hope-inspiring source of organs.

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ABO incompatible renal transplants: Good or bad?

Cited by 49 publications

References 94 publications

Renal transplantation in infants

Renal transplantation in infants

Long-term outcomes after ABO-incompatible kidney transplantation; a single-center French study

Trasplante renal grupo sanguíneo ABO incompatible. Experiencia colaborativa inédita España y Perú

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