Desensitization in ABO-Incompatible Kidney Transplantation With Low ABO Iso-Agglutinin Titers

Area of Science:

• Nephrology
• Immunology
• Transplantation Medicine

Background:

• Standard desensitization protocols for ABO-incompatible kidney transplantation (ABOi KT) may be excessive for patients with low iso-agglutinin titers (IGT).
• Evaluating reduced pre-conditioning requirements is crucial for optimizing ABOi KT protocols.

Purpose of the Study:

• To assess desensitization requirements for ABOi KT in patients with low IGT (<16).
• To determine if minimized desensitization protocols are safe and effective for ABOi KT with low IGT.

Main Methods:

• Retrospective study of ABOi KT recipients with IGT <16.
• Analysis of desensitization treatments including rituximab and plasma exchange (PE).

Main Results:

• Patient survival was 100% and renal graft survival was 90% at 1 and 5 years post-KT.
• A mean of 1.7 PE sessions were performed pre-KT, with 0.8 PE sessions post-KT on average.
• Low iso-agglutinin titers (≤8/8) were maintained post-transplant without rebound.

Conclusions:

• Recipients with IGT ≤8 required minimal or no post-transplant PE to achieve safe titers (≤4).
• Minimized desensitization protocols for ABOi KT with low IG titers can reduce adverse effects, costs, and logistical complexity.