Korean J Transplant.  2023 Nov;37(Suppl 1):S114. 10.4285/ATW2023.F-6958.

ABO-incompatible kidney transplantation: a single-center experience

• Yeom J
• Kim W
• Kang KP
• Kim H
• Shin YJ
• Yu HC
• Hwang HP
• Chung BH
• Lee S

• KMID: 2551734
• DOI: http://doi.org/10.4285/ATW2023.F-6958

Abstract

Background
Kidney transplantation (KT) is a renal replacement therapy that has a survival benefit compared to dialysis and improves the quality of life. According to the Korean Network for Organ Sharing Annual Report 2021, 31,055 patients were waiting for deceased donor KT (DDKT). Considering that only 2,227 underwent KT, ABO-incompatible KT has been an alternative to address this imbalance between demand and supply. We aim to share our experience with ABO-incompatible KT.
Methods
This study was a retrospective observational study conducted by extracting medical records. It included 42 patients who underwent ABO-incompatible KT at Jeonbuk National University Hospital (JBUH) from September 2014 to May 2023. All patients received a single dose of rituximab (mainly 200 mg/m2, 300 mg/m2 in patients at high immunological risk) 1 month before transplantation and received immunosuppressive therapy with tacrolimus, mycophenolic acid, and prednisolone initially.
Results
The average age of the 42 ABO-incompatible KT recipients was 48.45±12.16. To reach the target isoagglutinin level (at least ≤1:16), plasmapheresis has repeated an average of 4.36±2.66 times, and the isoagglutinin titer or serum creatinine was elevated after surgery for two patients, leading to the need for additional plasmapheresis. During the median follow-up period, the patient's survival rate was 97.6%, and only one patient's death was confirmed due to gastrointestinal bleeding. During the same period, graft failure was confirmed in two patients because of chronic rejection and BK nephropathy, respectively. In 42 ABO-incompatible KT recipients, there were 19 episodes of infection complications requiring hospitalization, followed by urinary tract infection, pneumonia, and varicella infection. In addition, eight surgical complications were identified, mainly due to bleeding/hematoma. Moreover, malignant tumors such as pancreatic cancer and squamous cell carcinoma in situ were confirmed in two patients after transplantation, respectively.
Conclusions
The clinical results of ABO-incompatible KT performed at JBUH were excellent, similar to those reported by other major centers.