ABO incompatible renal transplantation without antibody removal using conventional immunosuppression alone

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• ABO incompatible renal transplantation (ABOi) typically requires intensive immunosuppression and antibody removal.
• Outcomes of ABOi can be comparable to ABO compatible transplantation (ABOc).

Purpose of the Study:

• To evaluate the efficacy of standard immunosuppression alone for ABOi in recipients with low baseline anti-blood group antibody (ABGAb) titers.
• To determine if low ABGAb titers can predict successful ABOi without intensive antibody removal.

Main Methods:

• A series of 20 ABOi renal transplants were performed using conventional immunosuppression in recipients with low ABGAb titers (1:1 to 1:16).
• Transplant incompatibilities included A1 to O, A1 to B, A2 to O, AB to A, AB to B, B to A1, and B to O.
• Patient and graft survival, as well as rejection episodes, were monitored.

Main Results:

• 100% patient and graft survival at 36 months.
• One case of antibody-mediated rejection (AbMR) occurred in a patient with thrombophilia and low-level donor-specific anti-HLA antibody.
• Four patients experienced cellular rejection, all responsive to oral prednisolone.

Conclusions:

• Selected patients with low ABGAb titers can safely undergo ABOi with standard immunosuppression alone.
• Baseline ABGAb titer is a reliable predictor of AbMR risk in ABOi.
• This approach reduces morbidity, cost, and expands deceased donor options for ABOi.