ABO-incompatible living donor renal transplantation: Back to the future.
(2019) 26th BTS Annual Congress 2019 — Location: Antwerp, Belgium (14.March.2019)
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- Abstract
- BACKGROUND: More than 30 years after the first world series of ABO-incompatible living donor renal transplantation (ABOi-LKT) described by G.P. Alexandre in our Institution, this transplantation procedure has achieved worldwide the same success rate as ABO-compatible LKT. Objective: The aim of this study is to highlight the evolution of the therapeutic strategy during the last three decades for ABOi-LKT and to report our results in three recent consecutive procedures. Comparison between current and historical approach and outcomes will be presented. METHODS: ABO-LKT program started in 1982 until 1989 (n=39) and resumed from January 2018 (n=3). Our current desensitization before transplantation was obtained using rituximab and plasmapheresis to reach a titer less than 1/16, followed by triterapy immunosuppressive regimen, anti-CD25ab and according to the anti-A/B Ab titer, post-transplantation plasmapheresis. RESULTS: From the initial cohort graft survival reaches 41% at 20 years. In the recent series the maximum initial anti-A/B Ab titer was 1:256. One patient was HLA sensitized (PRA 38%). To obtain an acceptable anti-A/B Ab titer, 3-11 plasma exchange sessions were performed. All pairs underwent simultaneous uneventful kidney removal and transplantation surgeries and achieved immediate graft function recovery. No acute rejections occurred at follow up. Mean serum creatinine level at 116 days (median duration of follow-up) was 1.59 ± 0,16 mg/dl. No infection episodes or other surgical complications were observed. CONCLUSION: ABOi-LKT is a reasonable modality to increase the donor pool and currently achieve worldwide excellent results. Compared to the initial experience, the evolution of modern knowledge in the field of ABOi-LKT has allowed an improvement in outcomes, however we would like to stress that the basic principle of treatment remained globally unchanged.
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Buemi, A., De Meyer, M., Latinne, D., Lambert, C., Eeckhoudt, S., Darius, T., Goffin, E., Devresse, A., Kanaan, N., & Mourad, M. (2019). ABO-incompatible living donor renal transplantation: Back to the future. 26th BTS Annual Congress 2019, Antwerp, Belgium. https://hdl.handle.net/2078.5/31054