Outcome of desensitization in human leukocyte antigen and ABO incompatible living donor kidney transplantation: Single center experience of first 200 incompatible transplants

Abstract

Background and aims Although desensitization is well established, concerns about graft outcome, patient survival and rejection still exist. The present study aims at comparing outcomes of renal transplant recipients across simultaneous ABO and human leukocyte antigen (HLA) incompatibility barriers to those with ABO or HLA incompatibility alone. Materials and methods This was a retrospective study conducted from October 2015 to December 2018. All patients with a clinical diagnosis of chronic kidney disease, who were prospective HLA incompatible (HLAi) and/or ABO incompatible (ABOi) renal transplant recipients were included. A total of 400 cases including 36 ABOi transplants, 154 HLAi transplants, 10 simultaneously ABO and HLA incompatible transplants, and 200 ABO (ABOc) and HLA (HLAc) compatible kidney transplants from living donors were included. Results There were significantly more number of blood transfusions, previous transplants and pregnancies in HLAi transplant recipients relative to the ABOi or the control group. Mean number of therapeutic plasma exchange procedures per patient and mean plasma volume processed per procedure were slightly higher in the ABOi + HLAi category. The incidence of graft dysfunction due to suspected antibody‐mediated rejection during first year was highest in the ABOi + HLAi group, followed by ABOc + HLAi and ABOi + HLAc, lowest in the ABOc + HLAc category. Mean time to first episode of graft dysfunction was significantly shorter with incompatible transplants. There were no kidney transplant recipient deaths in the study. Conclusion Patient outcome and graft outcomes observed with incompatible transplants were not worse than those observed with compatible transplants.

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

“…Treatment for AMR due to human leukocyte antigen (HLA) antibodies is described elsewhere (see Transplantation, kidney, ABO compatible). Coexistent ABO and HLA incompatible kidney transplant recipients demonstrate higher risks of AMR than solely ABO or HLA incompatible cohorts (Ko, 2017;Pandey, 2021).…”

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

“…Table 1 summarizes the baseline characteristics of all ABOiKT procedures performed in this study along with a stratified analysis based on the various ABOiKT protocols used. The median age (interquartile range) of the recipients and donors at the time of ABOiKT was 40 (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)…”

“…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…”

Desensitization in Crossmatch-positive Kidney Transplant Candidates

“…During the following years, other authors reported their experiences with PP in association with rituximab for desensitization. [50][51][52][53] AMR has occurred within a range of 33% to 39%. Graft survival has been 89% after a median follow-up of 1.8 y and 66% at 4 y.…”