Introduction:
Renal transplant is the best and most cost-effective treatment modality for End Stage Renal Disease patients which is often challenging in resource limiting setting. ABO and Human leukocyte antigens (HLA) incompatibility are two important obstacles to renal transplant.
Methods:
Case I- 54-year male with donor – wife {(B to O) with anti B antibody titre -1:4096, Donor specific antibodies (DSA) against HLA - DRB3*01:01 Mean fluorescent Index (MFI) -1943)}.
Case II - 53-year female with peripheral vascular disease and Diabetes Mellitus with donor – husband {(AB to A) with anti B antibody titre -1:8, DSA against (HLA- A*68:01 – 1087 MFI) and HLA – DPB*01:13 -3730)}.
Case III - 34-year male with his mother-in-law as donor {(A to B) with anti A antibody titre (1:128) and DSA against DRB1*15:02 – MFI 1429)}.
Inj Rituximab-200mg was given 2 weeks prior followed by Immunoadsorption/Plasma Exchange and Rabbit anti thymocyte globulin for induction and standard three drug immunosuppression (Steroid/ Calcineurin Inhibitors/ Mycophenolate mofetil) with target blood group antibody titre < 1:8 and anti HLA - MFI <1000. Injection Methylprednisolone 500mg intravenous was given to all patient on the day of surgery prior to anastomosis.
Results:
After a mean follow up of 15 months; mean serum creatinine was 1.49mg/dl and mean Spot Urine Protein Creatinine Ratio was 0.55. Acute Antibody Mediated Rejection (ABMR) (n=1) occurred at 7 weeks and chronic active ABMR (n=1) at 7 months of transplant. Both patients responded well with treatment. 1st patient underwent re-exploration because of bleeding. 2nd patient developed Urinary Tract Infection (UTI) after 1 week of transplant and 3rd patient had TB after 13 months of transplant. Cytomegalovirus (CMV) infection, BK Virus infection and other opportunistic infections were not seen in any patient.
Conclusions:
Combined ABO and HLA incompatible Kidney transplant is a feasible and acceptable option in sensitised patients, especially in developing countries where long term dialysis facilities are quite expensive, inadequate and not easily accessible.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.