ABO-incompatible kidney transplantation: first cases in Turkey

Area of Science:

• Nephrology
• Transplantation Immunology

Background:

• ABO compatibility was traditionally essential for kidney transplantation (Ktx) to prevent antibody-mediated rejection.
• Advancements in immunosuppression and immunoadsorption have enabled ABO-incompatible Ktx.
• This study presents the first ABO-incompatible Ktx cases in Turkey for patients with dialysis inadequacy.

Purpose of the Study:

• To report the initial cases of ABO-incompatible kidney transplantation in Turkey.
• To evaluate the efficacy of a desensitization protocol involving Rituximab and immunoadsorption.
• To address organ shortage by utilizing ABO-incompatible donors.

Main Methods:

• Five dialysis patients (Blood groups O or B) received Ktx from ABO-incompatible living related donors (Blood group A1 or AB).
• Pre-transplant immunosuppression included Rituximab, tacrolimus, mycophenolate mofetil, and simvastatin.
• Immunoadsorption therapy was used pre- and post-operatively to reduce anti-A/anti-B antibody titers.

Main Results:

• No acute humoral or cellular rejection was observed in the transplanted patients.
• One patient was lost due to a cardiovascular complication during follow-up.
• The mean post-transplant creatinine level was 1.1 ± 0.3 mg/dL, indicating successful graft function.

Conclusions:

• ABO-incompatible kidney transplantation is a viable option in Turkey.
• The applied desensitization protocol effectively prevented rejection in these initial cases.
• This approach can significantly contribute to overcoming kidney transplant organ shortages.