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Living donor transplant options in end-stage renal disease patients with ABO incompatibility
Santosh S Waigankar1, Madhav H Kamat, Shriram Joshi
1Department of Urology and Renal Transplant, Jaslok Hospital and Research Centre, Mumbai, India.
Insights
For patients with end-stage kidney disease and donor shortages, ABO-incompatible (ABO-I) and paired-kidney exchange (PKE) transplants offer viable alternatives. Rituximab shows promise in ABO-incompatible transplants, improving outcomes and addressing donor scarcity.
Area of Science:
- Nephrology
- Transplantation Immunology
- Surgical Innovation
Background:
- End-stage renal disease (ESRD) patients face donor shortages, necessitating alternative transplantation strategies.
- Living donor kidney transplantation options include ABO-incompatible (ABO-I) and paired-kidney exchange (PKE) transplants for sensitized patients.
- This study reviews institutional experience with ABO-I, ABO-R (ABO-incompatible with Rituximab), and PKE transplants.
Purpose of the Study:
- To evaluate the outcomes of alternative living donor kidney transplantation methods.
- To compare the efficacy of ABO-incompatible transplant with and without Rituximab.
- To assess the feasibility of paired-kidney exchange in overcoming donor incompatibilities.
Main Methods:
- Retrospective analysis of 7 PKE, 26 ABO-I, and 7 ABO-R transplants performed between January 2008 and June 2011.
- Comprehensive pre-transplant evaluation of recipients and donors (biochemical, serological, radiological).
- Simultaneous surgical procedures for PKE; splenectomy for ABO-I and Rituximab administration for ABO-R.
Main Results:
- Graft and patient survival rates at 12-18 months: ABO-I (78.9%:80%), ABO-R (85.7%:85.7%), and PKE (100%:100%).
- Paired-kidney exchange demonstrated superior graft and patient survival.
- Rituximab inclusion in ABO-incompatible protocols showed promising results.
Conclusions:
- Rituximab-augmented ABO-incompatible transplantation is a promising strategy.
- Paired-kidney exchange effectively addresses donor shortages.
- Transplant choice involves balancing time (ABO-R) and cost (PKE) considerations with patient-nephrologist informed consent.
Introduction:
The options available to CKD 5 patients with donor shortage due to incompatibilities is to either get enlisted in cadaver transplant program or opt for three other alternatives viz; ABO-incompatible transplant (ABO-I), ABO-incompatible transplant with Rituximab (ABO-R) or paired-kidney exchange transplant (PKE). At our institute we have performed ABO-I, ABO-R and PKE transplants and we are presenting the results of these transplants performed at our institution. Here, we report our experiences of living donor kidney transplantation in highly sensitized patients.
Objective:
To review the options available to CKD 5 patients with incompatible donor.
Materials And Methods:
Between January 2008 and June 2011, 7 PKE, 26 ABO-I and 7 ABO-R transplants were carried out at our institute. Evaluation of both the recipients and donors involved biochemical, serological and radiological investigations. In case of PKE, recipients were operated simultaneously in different operation theaters. In ABO-I splenectomy was done while in ABO-R was given. Post-transplant the recipient management protocol remained the same. Expenditure following each transplant was calculated.
Results:
The graft and patient survival of ABO-I, ABO-R and PKE transplants 12-18 months after transplant were 78.9%:80%, 85.7%:85.7% and 100%:100%, respectively.
Conclusions:
The inclusion of Rituximab in the transplant protocol appears promising. The existing donor shortage could be addressed by encouraging other options like PKE. The limiting factor for ABO-R and PKE transplants is time and cost, respectively. The decision depends on the informed consent between the patient and the nephrologists.
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