Título

Desensitization for ABO Incompatible Kidney Transplantation: Experience of a Single Center in Brazil.

Introdução

Objective. About 25% of the living donors analyzed for kidney donation are ABO incompatible, but ABO incompatibility can be successfully overcome by using various desensitization protocols. We report our initial experience with incompatible ABO kidney transplants using a protocol based on Rituximab, plasmapheresis, Thymoglobulin, tacrolimus, mycophenolate and prednisone.

Material e Método

Patients and Methods. From October 2012 to June 2016, we performed 9 ABO incompatible kidney transplantation (KT) procedures from a living donor. The desensitization protocol was based on rituximab and PP. All patients received induction with Thymoglobulin and long-term steroids. Tacrolimus and mycophenolate sodium were initiated at the time of desensitization and continued after the transplant. Anti-ABO titers varied from 1/32 to 1/512, and transplants were cleared when titers reached values lower than 1/16.

Resultados

Results. After a mean follow-up of 22 (±13) months, all patients are alive. One patient lost the graft due to cellular rejection that occurred after reduction of immunosuppressive therapy for an aggressive HPV-related cervix cancer. The mean serum creatinine concentration is 1.1± 0.8 mg/dl. Two episodes of rejection occurred in 2 patients: one cellular and one antibody-mediated. Isoagglutinin levels in long-term vary from 1/2 to 1/32.

Discussão e Conclusões

Conclusions. Desensitization with rituximab and PP allowed us to perform transplants from living donors to ABO incompatible recipients with good results even in patients with high anti-ABO titers. The use of an intense plasmapheresis protocol for these high-titer patients did not impact on patient mortality.

Palavras Chave

Kidney transplantation- isoagglutinins- survival