ABO incompatible renal transplant: Transfusion medicine perspective

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• ABO incompatible renal transplantation presents challenges due to pre-formed antibodies.
• Therapeutic Plasma Exchange (TPE) is a key intervention to reduce antibody titers.
• Analyzing TPE trends pre- and post-transplant is crucial for optimizing outcomes.

Purpose of the Study:

• To analyze trends in ABO antibody titers.
• To determine the number of TPE procedures needed pre- and post-ABO incompatible renal transplant.
• To evaluate the efficacy of TPE in managing antibody titers and transplant outcomes.

Main Methods:

• Retrospective analysis of 29 patients undergoing ABO incompatible renal transplant.
• ABO antibody titers measured using the tube technique.
• TPE performed using albumin and Fresh Frozen Plasma (FFP); post-transplant TPE guided by antibody titers and graft function.

Main Results:

• Average of 4-5 TPE procedures pre-transplant and 2-3 post-transplant were required.
• Average titer reduction of 1-1.1 serial dilutions per TPE procedure for Anti-A and Anti-B.
• Reducing titers to <8 did not significantly impact transplant outcome (P=0.32), but post-transplant Anti-A and Anti-B titer differences were significant (P=0.042).

Conclusions:

• ABO incompatible renal transplantation can be successfully performed with TPE.
• The established TPE protocol effectively manages antibody titers.
• Further investigation into post-transplant titer dynamics may refine protocols.