Immune Desensitization Allows Pediatric Blood Group Incompatible Kidney Transplantation

Area of Science:

• Nephrology
• Immunology
• Pediatric Transplantation

Background:

• Blood group incompatible (ABOi) kidney transplantation in children is uncommon due to conditioning challenges and rejection risks.
• Pre-existing antibodies against donor ABO antigens pose a significant barrier to successful ABOi transplantation.

Purpose of the Study:

• To evaluate the efficacy and safety of a tailored desensitization protocol for pediatric ABOi kidney transplantation.
• To compare outcomes of pediatric ABOi kidney transplantation with ABO-compatible transplantation.

Main Methods:

• Retrospective analysis of 11 pediatric ABOi renal transplant recipients from two major UK centers.
• Utilized a desensitization protocol including rituximab, tacrolimus, mycophenolate mofetil, and antibody removal to reduce pre-transplant titers.
• No routine postoperative antibody removal was performed.

Main Results:

• 100% death-censored graft survival in ABOi recipients versus 98% in compatible transplants.
• Only one patient experienced grade 2A rejection, successfully treated. Another had a manageable titer rise.
• No histological evidence of rejection in 9 out of 11 ABOi patients. Viral infections (CMV, BK, EBV) were observed.

Conclusions:

• Tailored desensitization protocols yield excellent outcomes in pediatric ABOi kidney transplantation.
• Graft survival and rejection rates in pediatric ABOi recipients are comparable to those in ABO-compatible transplants.
• This approach offers a viable option for children requiring kidney transplantation, overcoming ABO barriers.