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ABO-Incompatible Kidney Transplantation: Low Rates of Infectious Complications and Excellent Patient Survival.

Y Shah1, K Almeshari1, D Broering1

  • 1King Faisal Specialist Hospital & Research Center, Department of Kidney and Pancreas Transplant, Riyadh, Saudi Arabia.

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|March 19, 2019
PubMed
Summary
This summary is machine-generated.

High-dose intravenous immunoglobulin (IVIG) use in ABO-incompatible kidney transplants (ABOi-KT) was associated with a low risk of infections and excellent patient survival. This approach may help reduce infectious complications in ABOi-KT recipients.

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Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Infectious Disease

Background:

  • End-stage renal disease creates a significant gap between organ demand and supply.
  • Kidney transplantation across ABO- and HLA-incompatible barriers increases the donor pool but heightens risks for recipients.
  • ABO-incompatible kidney transplant (ABOi-KT) recipients face increased risks of antibody-mediated rejection, infection, and mortality, often exacerbated by hypogammaglobulinemia from immunosuppression.

Purpose of the Study:

  • To evaluate the rate of infectious complications in ABOi-KT recipients.
  • To assess graft and patient survival rates following ABOi-KT.
  • To determine the potential impact of perioperative high-dose intravenous immunoglobulin (IVIG) on outcomes in ABOi-KT.

Main Methods:

  • Retrospective analysis of adult patients undergoing ABOi-KT between 2007 and 2016.
  • Standard immunosuppressive regimen including rituximab, plasma exchange, and high-dose IVIG (2 g/kg).
  • Induction therapy with Thymoglobulin and methylprednisolone; maintenance therapy with prednisone, mycophenolate mofetil, and tacrolimus.

Main Results:

  • A total of 77 ABOi-KTs were performed with a median follow-up of 1557 days.
  • One-year graft survival was 94.8%, and one-year patient survival was 100%.
  • No cases of pneumocystis, cytomegalovirus, herpes simplex, varicella zoster, or fungal infections were reported; two patients developed BK nephropathy.

Conclusions:

  • ABOi-KT in this series demonstrated a low incidence of infectious complications.
  • Excellent patient survival rates were observed in ABOi-KT recipients.
  • Perioperative high-dose IVIG may play a role in mitigating infectious risks in ABOi-KT.