Beginning of ABO-Incompatible Transplants in Pakistan: A Single-Centre Experience

Area of Science:

• Nephrology
• Transplant Surgery
• Immunology

Background:

• End-stage renal disease (ESRD) poses a growing challenge in Pakistan.
• Kidney transplantation is the optimal treatment for ESRD, superior to dialysis.
• ABO blood group incompatibility has historically limited kidney transplant options.

Purpose of the Study:

• To document the introduction of ABO-incompatible (ABOi) renal transplants in Pakistan.
• To evaluate the clinical outcomes, immunological responses, and graft survival rates of ABOi transplants.
• To refine pre-transplant desensitization protocols for ABOi kidney transplantation.

Main Methods:

• Retrospective analysis of 15 ABOi renal transplants performed between February 2023 and March 2025.
• Desensitization protocol: Rituximab, low-dose immunosuppression, and membrane plasma separation for antibody depletion.
• Induction therapy with anti-thymocyte globulin (ATG); maintenance immunosuppression with tacrolimus, mycophenolate mofetil (MMF), and prednisolone.

Main Results:

• Successful transplantation with pre-transplant antibody titers up to 1:512 (IgG) and 1:256 (IgM), using a cutoff of 1:4.
• Overall graft survival rate of 86.7%; 20% experienced cellular rejection, successfully treated.
• Key complications included lymphocele, urinary leakage, and infections (respiratory and urinary tract).

Conclusions:

• ABO-incompatible renal transplantation in Pakistan yields favorable clinical outcomes.
• This strategy significantly broadens the donor pool for patients suffering from ESRD.
• Continued adoption and refinement of ABOi transplantation can enhance patient survival and quality of life.