ABO-Incompatible Living-Donor Kidney Transplantation in a Developing Country: A Multicenter Experience in Malaysia

Area of Science:

• Nephrology
• Transplantation Immunology
• Clinical Medicine

Background:

• Malaysia faces challenges with deceased-donor kidney donation and lacks a paired kidney exchange program.
• ABO-incompatible and HLA-incompatible kidney transplantation are crucial for sustaining the national kidney transplantation program.

Purpose of the Study:

• To evaluate the safety and feasibility of ABO-incompatible living-donor kidney transplantation (LDKT) in Malaysia.
• To analyze outcomes of LDKT with varied desensitization protocols in recipients with high isoagglutinin titers.

Main Methods:

• Retrospective analysis of 26 ABO-incompatible LDKTs performed between 2011 and 2018 across three major Malaysian transplant centers.
• Data collection included perioperative and follow-up information up to June 2019.
• Utilized center-specific desensitization protocols (localized Japanese and Swedish) targeting anti-A/B isoagglutinin titers.

Main Results:

• Median follow-up was 62.3 months.
• Acute cellular rejection and antibody-mediated rejection occurred in 12.5% and 8.3% of cases, respectively.
• One-year patient, graft, and death-censored graft survival rates were 96.2%, 92.3%, and 96.0%; five-year rates were 96.2%, 87.2%, and 90.7%.

Conclusions:

• ABO-incompatible LDKT is a safe and feasible approach for kidney transplantation in Malaysia.
• Successful LDKT can be achieved even with high baseline isoagglutinin titers and varied desensitization regimens.
• This strategy contributes to the sustainability of the national kidney transplantation program.