First ABO-Incompatible Pediatric Kidney Transplant in South Africa-A Case Report

Area of Science:

• Nephrology
• Transplantation Immunology
• Pediatric Nephrology

Background:

• Blood group incompatibility traditionally limits living related donor (LRD) kidney transplantation.
• While ABO-incompatible transplants are established in adults and pediatric liver recipients, they remain underexplored in pediatric kidney transplant recipients in South Africa.

Observation:

• A 5-year-old male with end-stage kidney failure underwent a pre-emptive ABO-incompatible kidney transplant from his B+ sister (recipient A+).
• Desensitization involved a single Rituximab dose, reducing pre-transplant anti-B titers from 1:8 to 1:2.
• Post-transplant management included standard immunosuppression, with monitoring for antibody titers and graft function.

Findings:

• The patient achieved stable graft function with serum creatinine levels of 60-70 μmol/L at week 1, remaining stable at one year post-transplant.
• A transient increase in creatinine at 7 weeks was attributed to calcineurin inhibitor toxicity and resolved with dose reduction.
• No rejection episodes were observed during the one-year follow-up period.

Implications:

• This successful pediatric ABO-incompatible kidney transplant in South Africa demonstrates a viable strategy to overcome donor-recipient blood group disparities.
• It significantly broadens the potential donor pool for pediatric kidney transplant candidates, offering new hope for improved outcomes.