ABO incompatible renal transplantation in Argentina: experience in a tertiary referral university hospital
Carlos Chiurchiu1,2,3, Pamela Borgogno1,2,3, María Lujan Alaye1,2,3, Javier de Arteaga1,2,3, Walter Douthat1,2,3, Pehuén Fernandez1,2,3, Esteban Metrebián1,2, Juan Carlos Damonte1,2, Jorge de la Fuente1,2,3.
1Renal Transplant Program, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; 2Instituto de Ciencias Biomédicas de Córdoba, Córdoba, Argentina; 3Postgraduate School in Nephrology, UCC, Córdoba, Argentina
Introduction: ABO-incompatible renal transplant (ABOiTr) is little used in Argentina despite being able to increase the pool of donors. We report our experience with this modality in the period Jul/2014 – Mar/2022.
Study population and Methods: 177 living transplant donor were performed in the studied period of which 23 were ABOi (13%). Age of TrABOi: 48 years (20-76), 10 female (43%), second Tr 6/23 (26%), time on dialysis 21.8 months (3-60), preemptive 26%, non-related donor 52%, HLA missmatch 3.7 (0-6), presence of DSA in 22%. Median pre-Tr donor anti-group agglutinins: IgG 1/16 (0-1028), IgM 1/8 (0-256). Pre-Tr conditioning therapy included rituximab in 22/23 and plasmapheresis (PF) in 20/23 with a median of 4 sessions (range 1-9). Two patients received PF post ABOi Tr. All received immunosuppression with tacrolimus and mycophenolate one month pre-Tr and continued post-Tr. Intravenous immunoglobulin (IVIG) was used in all patients post last PF and antithymocyte globulin as induction in 20/23 patients.
Results: Mean follow-up post-Tr was 37.4 months (1-92). Six patients developed acute rejection (AMR: 4, TCMR: 2). Rejection treatment included corticosteroids pulses and IVIG in all cases. Bortezomib was used in one case and PF in another. All patients except one responded to treatment. The most frequent post-Tr complications were: urinary tract infections in 7 patients one of them with sepsis, BK reactivation in 2 cases and 1 case of immediate post-Tr hemorrhage. Nine patients developed COVID infection (39%), 3 of them required hospitalization. One graft loss was recorded at 6 months post-Tr due to refractory AMR. Three patients died in the study period, two deaths related to COVID infection (1 and 33 months post-Tr) and one death was related to PTLD (49 months post-Tr), all deaths were with a functioning kidney (median patient survival 89%). Creatinine level in last control was 1.53 mg/dl (0.90-2.70 mg/dl) and P/C 0.18 (0.1-1.0).
Conclusion: ABOiTr is a feasible alternative in our country, these preliminary results suggest that it should be offered more extensively to recipients who do not have an ABO compatible donor.
Fundación Nefrológica de Córdoba.
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