ESPN 51th Annual Meeting

ESPN 2018


 
Successful kidney transplantation with an ABO incompatible deceased donor: strategy to reduce waiting lists
ANN CHRISTIN GJERSTAD 1 ANNA BJERRE 1 RUNE HORNELAND 2 CHRISTINA DÖRJE 2

1- DIVISION OF PAEDIATRIC AND ADOLSECENT MEDICINE
2- DEPARTMENT OF TRANSPLANTATION MEDICINE
 
Introduction:

ABO incompatible kidney transplantation (ABOi Ktx) requires preconditioning treatment with B cell depletion (Rituximab), extracorporeal blood group antibody removal, plasmapheresis or ABO antigen-specific immune-absorption and pre-transplant prednisolone combined with mycophenolate mofetil. We report hereby a patient with low anti A titers listed for deceased donor (DD), who was successful ABOi transplanted without pre-conditioning.

Material and methods:

A 16 month old girl with Denys Drash syndrome, was listed for DD Ktx. Her weight was 9 kilo. She had peritoneal dialysis (PD) since birth and bilateral nephrectomy at 6 month of age. Her blood group was O, but her anti A titers against selected A1 blood donors were low (IgM 1, IgG < 1). We got the possibility to do a DD ABOi Ktx, A→O, with anti A IgM<1 and anti A IgG<1, HLA donor specific antibodies (DSA) negative, crossmatch negative and HLA mismatch was 3-2. After premedication with Rituximab and immunoglobulin (IVIG) just hours before transplantation, surgery was performed.

Results:

Daily anti A titers remained low. The first week of recovery was complicated by establishment of a chronic Noro virus enteritis. Three weeks after transplantation rapid increase in creatinine 93 µmol/L, diagnosed an acute cellular rejection Banff IB without sings of antibody mediated injury (i3, t3, v0, C4d negative) treated successfully with pulsed intravenous methylprednisolone. The girl is now 3 years, latest creatinine is 32 µmol/L, with no de novo DSA, and anti A titers against selected A1 blood donors remains low (IgM 1, IgG < 1).

Conclusions:

Anti A antibodies in children with blood group O develops during the first years of life. Children with end stage renal disease (ESRD) listed for DD Ktx should be investigated for anti A and B titers to enable ABOi Ktx in case of a ABOi donor is avalible. This strategy could potentially reduce waiting list time.