Abstract: SA-PO014
Successful Kidney Transplantation in Adults with Antibody Deficiencies
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Schoutteten, Melanie, Maastricht University Medical Centre, Eersel, Netherlands
- Christiaans, Maarten H.L., Maastricht University Medical Centre, Eersel, Netherlands
Introduction
Antibody deficiencies (common variable immunodeficiency (CVID) and hypogammaglobulinemia (HGG)) associate with a high prevalence of infections, autoimmunity, granulomas and malignancies. Immune suppression in transplantation may amplify this risk. Therefore, in many centers these patients are not considered as suitable candidates for renal transplantation. In literature, only 2 cases of kidney transplantation in CVID patients are reported, both with bad short-term outcome. Because our center has a long track record in kidney transplantation with reduced immune suppression we decided to develop a set of preconditioning criteria and pioneered a transplantation program. We present 1 patient with CVID and 1 with HGG, both transplanted with good clinical and renal outcome.
Case Description
A 43-year old female known with ESRD due to reflux nephropathy and CVID, received a 43-year old DBD-renal transplant. Immunosuppression consisted of tacrolimus and low dose steroids. IVIG was continued. Protocol biopsy at month 3 was normal and steroids were withdrawn. Posttransplant, she had a few recurrent urinary and respiratory infections for which prophylactic azithromycin was given. 3 years posttransplantation patient is still in good clinical condition without malignancies and with a persistent good renal function (eGFR 40ml/min).
A 61-year old male with ESRD due to polycystic kidney disease, known with HGG, was transplanted with a 64-year old DCD donor kidney with IGF. Immunosuppression consisted of tacrolimus, low dose steroids for 10 days and mycophenolate mofetil for 3 months. IVIG was continued. He had no acute rejection nor infection besides twice an asymptomatic cystitis. Until now, 2 years after transplantation, he has a persistent renal function of 28.3ml/min.
Discussion
Uniqueness of the cases
We present 2 pioneer cases of successful renal transplantation in patients with antibody deficiency.
Take away lesson
Our data provide a framework for a pre-transplant risk reduction strategy combined with a specific immune suppressive regimen under an umbrella of IVIG supplementation allowing safe kidney transplantation of immune deficient patients.