EXPERIENCES OF PERFORMING ABO-INCOMPATIBLE KIDNEY TRANSPLANTATION IN ARGENTINA

Introduction:

Living donor kidney transplantation represents the optimal renal replacement therapy for patients with end-stage chronic kidney disease. It is estimated that 30% of potential living donors are discarded due to blood group incompatibility/anti-HLA antibody. The high mortality rate associated with dialysis underscores the potential value of considering incompatible transplantation with an appropriate desensitization protocol as an alternative. In this study, we present our results in ABO incompatible transplantation.

Methods:

Retrospective, observational and descriptive cross-sectional study conducted between 2015 and 2023 in patients with ABO-incompatible kidney transplants. Immunological risk was classified as low <1/8, moderate 1/16-1/64 and high 1/128-1/256 according to the antibody titer against the potential donor's blood group. Isoagglutinin titration was performed using a semiquantitative titration technique. The desensitization protocol included rituximab, plasma exchange (PEX) and intravenous immunoglobulin according to risk categorization. All patients were monitored post-renal transplantation with daily isoagglutinin determinations during hospitalization and weekly on an outpatient basis until day +15. Data are presented as absolute and relative frequencies for categorical variables and as median (IQR) or mean ± SD for continuous variables.

Results:

The baseline donor and recipient characteristics are summarized in table 1. The mean baseline anti-ABO IgM/IgG antibody titres were 1:32 and 1:64 respectively (range, 1:4-1:128). Our patients received on average six sessions of PEX before transplantation and one post-transplantation (table 2). Overall patient and graft survival at 1 year was 90%. Mean GFR was 74 ± 18 ml/min/1.73 m2. Two out of ten patients had acute post-transplant rejection (+14 days and +7 months post-transplant), none had pre-transplant DSA.  Infection was the most frequently observed complication. One patient lost the graft and died due to septic shock secondary to herpesvirus 6 (table 3). Plasmapheresis-related, surgical and infectious complications are summarized in table 3.

Conclusions:

ABOi kidney transplantation is a complementary option to a Paired Kidney Donation programme and the appropriate use of marginal deceased donors for those who do not have a donor match. Strengthening these unconventional modalities of kidney transplantation in Argentina will increase the number of kidney transplants to reduce the waiting list and decrease  mortality in the waiting list. However, high costs and infections remain major concerns.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.