[AB0 incompatible kidney transplantation - first experiences]

Area of Science:

• Nephrology
• Immunology
• Transplantation Science

Background:

• Living donor ABO incompatible kidney transplantation offers a vital solution to increase transplant access.
• European protocols commonly utilize rituximab, triple immunosuppression, IVIG, and immunoadsorption (IA) to eliminate specific antibodies.
• ABO incompatible kidney transplantation is a growing area in transplant medicine.

Purpose of the Study:

• To evaluate the outcomes of a living donor ABO incompatible kidney transplantation program.
• To assess the safety and efficacy of desensitization protocols including immunoadsorption.
• To explore the role of ABO incompatible transplantation in improving donor-recipient matching.

Main Methods:

• Initiation of an ABO incompatible kidney transplant program in 2011.
• Implementation of desensitization protocols involving rituximab, triple immunosuppression, IVIG, and serial immunoadsorption (IA).
• Monitoring of isohaemagglutinin titers, IA procedures, and post-transplant complications.

Main Results:

• Twenty-one ABO incompatible kidney transplants were performed.
• Pre-transplant isohaemagglutinin titers up to 1:64 required 2-9 IA procedures.
• Five patients received post-transplant IA. Main complications included bleeding and UTIs. C4d staining was common in biopsies.
• No graft loss or patient death occurred.

Conclusions:

• Living donor ABO incompatible kidney transplantation is a safe and effective strategy to expand transplant options.
• The established desensitization protocol, including IA, is well-tolerated and prevents graft loss.
• Further integration with paired exchange programs can optimize HLA matching in ABO incompatible transplants.