Clinical outcomes of ABO-incompatible kidney transplant with rituximab and double-filtration plasmapheresis

Area of Science:

• Nephrology
• Transplantation Immunology

Background:

• Kidney transplantation is the optimal treatment for end-stage renal disease (ESRD).
• A significant shortage of donor organs leads to prolonged waiting times for kidney allografts.
• ABO-incompatible kidney transplantation offers a strategy to broaden the donor organ pool.

Purpose of the Study:

• To evaluate the efficacy and safety of ABO-incompatible kidney transplantation.
• To assess a preconditioning protocol involving double-filtration plasmapheresis and rituximab in 13 ESRD patients.

Main Methods:

• Retrospective analysis of 13 ABO-incompatible kidney transplant recipients from January 2011 to August 2012.
• Preconditioning regimen included rituximab, mycophenolate mofetil, tacrolimus, corticosteroids, double-filtration plasmapheresis, and intravenous immunoglobulin.
• Monitoring of antibody titers and patient outcomes, including rejection episodes, complications, and graft survival.

Main Results:

• No instances of acute T-cell or antibody-mediated rejection were observed.
• One patient experienced postoperative bleeding; otherwise, no surgical complications occurred.
• Excellent graft function was noted, with a mean serum creatinine of 71 ± 18 μmol/L at two weeks post-transplant. No graft loss or patient death occurred during a mean follow-up of 267 days.

Conclusions:

• The employed preconditioning protocol, including double-filtration plasmapheresis and rituximab, facilitated successful ABO-incompatible kidney transplantation.
• This approach can increase kidney allograft availability, potentially shortening or eliminating the need for dialysis.
• Further multicenter research is warranted to establish a standardized preconditioning protocol for ABO-incompatible kidney transplants.