Outcome of ABO-Incompatible Living Donor Renal Transplantations: A Single-Center Experience From Eastern India

With the incessantly increasing number of patients on the waiting list for renal transplants, crossing the blood group barrier can substantially increase the donor pool. We started ABO-incompatible (ABOi) renal transplantation in 2013 with a relatively low-cost preconditioning protocol (additional cost, ∼$1200). This study reports the short-term outcome of ABOi renal transplantations performed at our institution.

A total of 45 adult ABOi kidney transplant recipients (KTRs) were included in the study. All of them underwent a pretransplantation conditioning program, which included plasmapheresis, low-dose intravenous immunoglobulin (IVIG), and low-dose rituximab. A pretransplantation isoagglutinin titer of ≤1:8 was considered acceptable for transplantation until December 2014, after which the threshold was increased to ≤1:32.

Overall, 50% of KTRs were of blood group O. The maximum initial antibody titer was 1:2048. All the patients achieved immediate graft function post-transplantation. The mean serum creatinine level at 370 days (median duration of follow-up) was 1.21 mg%. One graft was lost due to severe antibody-mediated rejection (ABMR) with cortical necrosis. The graft survival rate was 97.78% and the patient survival rate was 97.78%. The overall result in terms of graft and patient survival, infections, and rejections were similar to ABO-compatible transplantations.

ABOi renal transplantation is a cost-effective modality to increase the donor pool. Contrary to the belief that this modality is extremely expensive and requires elaborate infrastructure, we had a good short-term outcome with a relatively simple and low-cost preconditioning protocol.