ABO Incompatible Kidney Transplantation in Indian Children

Area of Science:

• Nephrology
• Transplantation immunology
• Pediatric surgery

Background:

• Kidney transplantation in developing nations relies heavily on live donors, leading to extended waiting lists for patients lacking ABO compatible (ABOc) donors.
• ABO incompatible (ABOi) kidney transplantation offers a viable strategy to broaden the donor pool.
• This study details the center's experience with pediatric ABOi kidney transplantation.

Purpose of the Study:

• To evaluate the feasibility and outcomes of ABO incompatible (ABOi) kidney transplantation in children.
• To compare the results of ABOi kidney transplantation with ABO compatible (ABOc) transplantation in a pediatric cohort.
• To assess graft survival, patient survival, and renal function post-transplantation.

Main Methods:

• A retrospective analysis of medical records for pediatric kidney transplantations (ABOi and ABOc) performed between January 2019 and December 2023.
• Desensitization protocols for ABOi recipients included rituximab, immunoadsorption or plasma exchange, and IVIg.
• Induction therapy utilized basiliximab or ATG, followed by maintenance immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone.

Main Results:

• Seven ABOi and 46 ABOc kidney transplantations were performed over five years, with comparable patient and donor characteristics.
• Rejection-free graft survival rates were similar between the ABOi and ABOc groups (p=0.88).
• Median estimated glomerular filtration rate (eGFR) at last follow-up was comparable (61.4 ml/min/1.73 m² in ABOi vs. 50.9 ml/min/1.73 m² in ABOc; p=0.23), with similar patient and graft survival rates.

Conclusions:

• Pediatric ABO incompatible kidney transplantation in India is a feasible procedure.
• The outcomes, including graft survival and renal function, are satisfactory and comparable to ABO compatible transplants.
• ABOi transplantation effectively expands donor options for children requiring kidney transplants.