Korean J Transplant.  2023 Nov;37(Suppl 1):S52. 10.4285/ATW2023.F-6163.

Different short-term clinical outcome of living donor kidney transplantation with ABO incompatibility

• Saragih RJ
• Hasiholan Marbun MB
• Susalit E

• KMID: 2551639
• DOI: http://doi.org/10.4285/ATW2023.F-6163

Abstract

ABO-incompatible kidney transplantation is a safe option to address the kidney donor supply-demand disparity. However, its outcomes in developing countries are not well-known. In this study, we compare two cases of ABO-incompatible kidney transplantation. Patient 1 is a 17-year-old female on dialysis, with end-stage kidney disease caused by chronic glomerulonephritis. She received a kidney donor from her mother, who had different blood type (patient B+, donor AB+). Her baseline anti-A immunoglobulin M (IgM) titer was 1:256. Patient 2, a 46-year-old male with the same diagnosis, received a donor from an unrelated male with different blood type (patient O+, donor B+). His baseline anti-B IgM titer was 1:32. Modified desensitization protocol was used for both patients, using rituximab, triple immunosuppression (tacrolimus, mycophenolic acid, methylprednisolone), plasmapheresis (six sessions and three sessions, respectively), followed by intravenous immunoglobulin. Both patients achieved a preoperative antibody titer of anti-A IgM and anti-B IgM of 1:16 for patient 1 and 2, respectively. Basiliximab was used as induction therapy. Both patients underwent successful allograft renal implantation without any clinical signs of hyperacute rejection. During a 2-day monitoring period in the intensive care unit, both patients remained stable. Patient 1 experienced a significant reduction in serum creatinine levels, from 9.6 mg/dL to 2.4 mg/dL within 24 hours, and continued to improve. Conversely, despite daily diuresis of more than 1.5 liters, patient 2 failed to achieve a postoperative decrease in creatinine levels and had to undergo hemodialysis on the fourth day posttransplantation. Further clinical and pathology data indicated that patient 2 experienced accelerated graft rejection, leading to nephrectomy. Both patients were eventually discharged safely. These cases emphasize the importance of considering the ABO blood group antibody titer in combination with other clinical characteristics before opting for high-risk kidney transplantation procedures. Donor-recipient relatedness status and the number of plasmapheresis sessions may potentially influence the outcomes.