Abstract: SA-PO1160
Outcome of ABO Incompatible Kidney Transplantation: With and Without Anti-CD20 Antibody Use
Session Information
- Transplantation: Clinical - Rejection, Recurrent Disease, Incompatibility
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Sharma, Amit, Fortis Hospital, Mohali, India
- Gill, Harinder Jit Singh, Fortis Hospital, Mohali, India
Background
ABO-incompatible (ABOi) kidney transplants help in crossing an important immunological barrier against kidney transplantation. The study was conducted to assess the feasibility of performing ABOi kidney transplants without the use of Anti CD20 antibody and comparison of their outcomes with ABOi kidney transplants using Anti CD20 antibody.
Methods
The study, conducted between April 2014 and March 2019, included 54 live donor ABOi transplant recipients. They were divided into two groups based on using rituximab ABOiR+ (n=21) or without rituximab ABOiR- (n=33). All Patients were started on Tacrolimus, Mycophenolate mofetil and Prednisolone 10 days prior to tentative date of transplant. In addition, ABOiR+ group received Injection Rituximab 200 mg. Plasmapheresis was done and low dose intravenous immunoglobulin (100 mg/kg) given until an acceptable isoagglutinin titer (1:4) was obtained on the date of transplantation. All patients received induction immunosuppression: Thymoglobulin (1 mg/kg/day for 3 days). Main Outcome Measures: Patient and allograft survival; 1-, 3-, 6-, 12-, and 18-month renal function; infectious complications; and incidence of rejection.
Results
19.04% of the ABOiR+ recipients and 30.3% of ABOiR- recipients were females. Median isoagglutinin titer at start was 1:32 (1:1 to 1:256) in ABOiR- group and 1:8 (1:1 to 1:256) in ABOiR+ group. Mean number of plasmapheresis required were 3 in ABOiR- group and 2 in ABOiR+ group. There was no significant difference between the post transplant serum creatinine in the two groups. In the ABOiR- group, there were 6 episodes of biopsy proven acute antibody mediated rejection (AMR) and 1 patient had acute cellular rejection (ACR). 1 episode each of AMR and ACR was observed in the ABOiR+ group. Two patients succumbed to fungal sepsis in the ABOiR- group while three patients died of pneumonia in ABOiR+ group.
Conclusion
This study suggests that with the use of Anti-CD20 treatment, successful ABOi transplantation is possible with lower incidence of AMR but is associated with increased incidence of sepsis.