How to reduce lethal infectious complications in ABO-incompatible kidney transplantation.

Area of Science:

• Nephrology
• Transplantation Immunology
• Infectious Diseases

Background:

• ABO-incompatible kidney transplantation expands the donor pool but carries risks of post-operative infectious complications due to pre-conditioning antibody removal.
• Pre-conditioning regimens, while necessary, can lead to severe infections, impacting patient outcomes.

Purpose of the Study:

• To evaluate the impact of a modified immunosuppressive strategy on infectious complications following ABO-incompatible kidney transplantation.
• To determine if an adjusted pre-conditioning protocol can improve safety and graft outcomes.

Main Methods:

• A cohort of 182 patients undergoing ABO-incompatible kidney transplantation was studied.
• An initial cohort (n=85) received standard pre-conditioning; a subsequent cohort (n=97) received a modified protocol (reduced rituximab, selective calcineurin inhibitors, reduced anti-metabolites, and prophylactic measures).
• Post-operative infectious complications were analyzed and compared between the two groups.

Main Results:

• The modified protocol significantly reduced infectious complications, including cytomegalovirus (64.7% vs 27.8%) and BK viremia (35.2% vs 18.6%).
• No deaths occurred in the modified protocol group, compared to 8.2% in the initial group (P = .03).
• Acute rejection rates and death-censored graft survival remained similar between groups.

Conclusions:

• Pre-conditioning for ABO-incompatible kidney transplantation is essential, but its risks can be mitigated by a tailored immunosuppressive strategy.
• Modified immunosuppression, adapted to patient conditions, enables safe ABO-incompatible kidney transplantation with successful graft outcomes.