Korean J Transplant.  2022 Jun;36(2):111-118. 10.4285/kjt.22.0014.

Experiences of performing ABO-incompatible kidney transplantation in Bangladesh

• Begum NAS
• Kashem TS
• Nobi F
• Arefin SUZ
• Rashid HU

• KMID: 2531134
• DOI: http://doi.org/10.4285/kjt.22.0014

Abstract

Background
The number of end-stage renal disease (ESRD) patients is increasing in Bangladesh. Currently, living kidney donation is the only viable option for transplan-tation in Bangladesh, and it is further restricted by ABO compatibility issues. We have performed ABO-incompatible kidney transplantations (ABOi KTs) in Bangladesh since 2018. This study examines our experiences with seven cases of ABOi KT.
Methods
The desensitization protocol included low-dose rituximab (100 mg/body) fol-lowed by plasma exchange (PEX), which was followed by a 5-g dose of intravenous im-munoglobulin. Immunosuppression was undertaken using tacrolimus (0.1 mg/kg/day), mycophenolate mofetil (1,500 mg/day), and prednisolone (0.5 mg/kg/day). All patients received basiliximab for induction therapy.
Results
The median baseline anti-ABO antibody titer was 1:64 (range, 1:32–1:128). Transplantation was performed at a titer of ≤1:8. Our patients attended three to five PEX sessions before transplantation. Graft survival was 100% in the seven cases over a mean period of 22 months. The mean creatinine level was 204.6±47.4 µmol/L. Two patients were suspected of having developed acute rejection and received intravenous methylprednisolone, resulting in improved kidney function. One patient required post-transplant hemodialysis due to delayed graft function and subsequently improved. Infection was the most common complication experienced by ABOi KT patients. Two pa-tients developed severe cytomegalovirus pneumonia and died with functioning grafts.
Conclusions
ABOi KT in Bangladesh will substantially expand the living kidney donor pool and bring hope to a large number of ESRD patients without ABO-compatible do-nors. However, the high cost and risk of acute rejection and infection remain major concerns.

Keyword

Blood group incompatibility; Kidney transplantation; Plasma exchange; Chronic kidney failure; Bangladesh

Figure

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  Fig. 1 Desensitization protocol. TAC, tacrolimus; MMF, mycophenolate mofetil; PEX, plasma exchange; IVIG, intravenous immunoglobulin; TX, transplant.

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