Outcomes of abo-incompatible kidney transplantation: Novel ways of reducing rejection, complications, and cost

Q4 Medicine Transplantation Reports Pub Date : 2023-06-01 DOI:10.1016/j.tpr.2023.100127

Vivek Pathak , Madhav Venkatesan , Devdas Madhavan , S Balasundaram , N Kuppurajan , Sampath kumar , Gabor Bodonyi-Kovacs

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Abstract

Aim

Our objective was to report the outcomes of ABO-incompatible (ABOi) transplants and seek solutions to pretransplant desensitization, peri and postoperative bleeding events, acute rejection and infection-related mortality.

Methods

We retrospectively analyzed 247 consecutive ABOi kidney transplantations at our center from June 2012 to March 2020. The primary outcomes were patient, graft, and death-censored graft survival over 5 years.

Results

A total of 31 patients received thymoglobulin and 216 patients received basiliximab induction. Patient survival rates with basiliximab induction at 1, 3, and 5 years were 97.8%, 93.5%, and 93.5%, respectively; corresponding graft survival rates were 95.1%, 86.6%, and 85.2%, respectively. Overall, biopsy-proven acute rejection occurred in 11.7% recipients; primarily due to antibody-mediated rejections. Cumulative incidence of graft loss was 7.5% at 5 years and overall incidence of death was 6.07%.

Conclusion

Replacement of filtered plasma by donor group fresh frozen plasma rather than albumin reduced bleeding, IVIG administration, number of plasmapheresis sessions and the need for filters. Thymoglobulin avoidance decreased acute rejection rates. Rapid reduction and lower doses of prednisolone and MMF reduced infectious complications. These steps can help reduce rejection rates, complications and cost (up to USD 7000) comparable to ABO compatible transplantation in other centers as well.

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abo不相容肾移植的结果:减少排斥反应、并发症和成本的新方法

目的我们的目的是报告ABO血型不合（ABOi）移植的结果，并寻求移植前脱敏、围术期和术后出血事件、急性排斥反应和感染相关死亡率的解决方案。方法回顾性分析2012年6月至2020年3月在我中心连续进行的247例ABOi肾移植。主要结果是患者、移植物和死亡审查的移植物5年生存率。结果共有31例患者接受胸腺球蛋白治疗，216例患者接受巴利昔单抗诱导治疗。在1年、3年和5年时，使用巴西利昔单抗诱导的患者生存率分别为97.8%、93.5%和93.5%；相应的移植物存活率分别为95.1%、86.6%和85.2%。总体而言，经活检证实的急性排斥反应发生在11.7%的受试者中；主要是由于抗体介导的排斥反应。5年时移植物丢失的累积发生率为7.5%，总死亡发生率为6.07%。胸腺球蛋白的回避降低了急性排斥反应的发生率。泼尼松龙和MMF的快速减少和低剂量减少了感染性并发症。与其他中心的ABO兼容移植相比，这些步骤可以帮助降低排斥反应率、并发症和成本（高达7000美元）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation Reports Medicine-Transplantation

CiteScore

0.60

自引率

0.00%

发文量

审稿时长

101 days

期刊介绍： To provide to national and regional audiences experiences unique to them or confirming of broader concepts originating in large controlled trials. All aspects of organ, tissue and cell transplantation clinically and experimentally. Transplantation Reports will provide in-depth representation of emerging preclinical, impactful and clinical experiences. -Original basic or clinical science articles that represent initial limited experiences as preliminary reports. -Clinical trials of therapies previously well documented in large trials but now tested in limited, special, ethnic or clinically unique patient populations. -Case studies that confirm prior reports but have occurred in patients displaying unique clinical characteristics such as ethnicities or rarely associated co-morbidities. Transplantation Reports offers these benefits: -Fast and fair peer review -Rapid, article-based publication -Unrivalled visibility and exposure for your research -Immediate, free and permanent access to your paper on Science Direct -Immediately citable using the article DOI