Renal transplantation across ABO barrier

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• Renal transplantation in India often excludes patients lacking compatible blood donors.
• Long-term dialysis poses significant challenges, particularly for young patients.

Observation:

• A 19-year-old male, blood group O+, lacked a compatible donor.
• His mother, blood group B+, was a potential donor, despite ABO incompatibility.

Findings:

• The patient underwent plasmapheresis (11 sessions), intravenous immunoglobulin (IVIG), and rituximab for antibody depletion.
• Pre-transplant anti-B antibody titers decreased from 1:512 to <1:8.
• Post-operative management included four plasmapheresis/IVIG sessions due to titer rebound.
• Six months post-transplant, the patient maintained normal renal function (creatinine 1.4 mg/dL) without rejection.

Implications:

• This case demonstrates the feasibility of ABO-incompatible kidney transplantation in resource-limited settings.
• Successful antibody depletion protocols can expand donor pools and improve outcomes for patients needing transplants.
• This approach offers a viable alternative to prolonged dialysis for young patients with end-stage renal disease.