Individualized preconditioning for ABO incompatible living donor kidney transplantation: An initial report of 48 cases from China
Xianding Wang1, Jinpeng Liu1, Tao Lin1.
1Urology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
Background: ABO incompatible (ABOi) living donor kidney transplantation (KTx) is well established in developed countries, but not yet in China.
Material and Methods: We developed individualized preconditioning protocols for ABOi KTx based on initial ABO antibody titers. After propensity score matching of ABOi with ABO compatible (ABOc) KTx, post-transplant outcomes were compared.
Results: Between September 2014 and June 2018, 48 ABOi living donor KTx candidates received individualized preconditioning, and all underwent subsequent KTx (median initial ABO titers: 16 for IgM and 16 for IgG). Thirty-one recipients (64.6%) were preconditioned with rituximab (median dose: 200 mg, range: 100–500 mg). Among 37 patients (77.1%) who received pre-transplant antibody removal, the median number of sessions of antibody removal required to achieve ABOi KTx was 2 (1-5) which was conducted between days -10 and -1. Eleven ABOi recipients (22.9%) were preconditioned with oral immunosuppressants alone. Hyperacute rejection led to the loss of two grafts in the ABOi group. After a median follow-up of 27.6 months (ABOi group) and 29.8 months (ABOc group), there were no significant differences in graft/recipient survival, rejection, and infection. There were marginally higher rates of severe thrombocytopenia (<50×109/L) (P=0.073) and delayed wound healing (P=0.096) in ABOi recipients.
Conclusion: Our individualized preconditioning protocol evolved as our experience grew, and the short-term clinical outcomes of ABOi KTx did not differ from those of matched ABOc patients. ABOi KTx may be a major step forward in expanding the kidney living donor pool in China.
This study was collectively supported by grants from the National Natural Science Foundation of China (81870513, 81470980, 81600584), Sichuan Science and Technology Program (2019YJ0133), the Fundamental Research Funds for the Central Universities (2017SCU11022), and 1.3.5 Project for Disciplines of Excellence- Clinical Research Incubation Project, West China Hospital, Sichuan University (2018HXFH049, ZY2016104, ZYJC18004). The funders had no role in study design, data collection or analysis, preparation of the manuscript, or the decision to publish..
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