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Year : 2022  |  Volume : 16  |  Issue : 1  |  Page : 56-60

Clinical outcome of ABO-Incompatible kidney transplant with low baseline anti-A/B antibody titer without the use of plasma exchange - A retrospective study

1 Department of Nephrology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
2 Department of Urology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
3 Department of Transfusion Medicine, Aditya Birla Memorial Hospital, Pune, Maharashtra, India

Correspondence Address:
Dr. Tarun Kumar Jeloka
Department of Nephrology, Aditya Birla Memorial Hospital, Pune - 411 033, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijot.ijot_60_21

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Background: The outcome of ABO-incompatible (ABOi) transplant (Tx) may be compromised because of the need for added immunosuppression. Many centers still use plasma exchange (PEX) even when anti-A/B titers are low. We compared the outcome of ABOi kidney Tx with low baseline anti-A/B titers without PEX to those with high titers managed with PEX and to ABO-compatible (ABOc) Tx. Materials and Methods: In this retrospective study, all adult kidney Tx done at our institute were eligible. Patients <18 years of age, deceased donor transplant recipients, and those with hepatitis B, C or HIV infections at the time of transplant were excluded from this analysis. Outcomes including biopsy-proven AR, estimated glomerular filtration rate (eGFR) (Modification of Diet in Renal Disease equation), infections, and patient and graft survival were determined in ABOi kidney Tx with low baseline anti-A/B antibody titers managed without PEX (Group A). These outcomes were compared to a contemporary cohort of those with high titers and use of PEX (Group B) and ABOc Tx (Group C). Continuous variables were compared by Student's t-test and categorical variables with Chi-square test. Patient and graft survival was calculated by Kaplan–Meier curve and compared between the groups by log-rank test. Results: Baseline characteristics reveal no difference in recipients and donor factors such as age, gender, and HLA match. Initial immunoglobulin G anti-A/B titers were higher in Group B as compared to Group A (P = 0.04), but final titers pretransplant were similar (P = 0.6). Biopsy-proven rejections were not different between Groups A and B or Groups A and C. Serum creatinine and eGFR at 1 month and at last follow-up were also similar in all the groups. Infections were seen in 22.2% of the patients in Group A, 44.4% in Group B, and 27.7% in Group C. Patient survival and death-censored graft survival were similar in all three groups. Conclusion: This retrospective study shows that patients with low baseline anti-ABO antibodies managed without PEX are safe and have similar outcomes such as patient and graft survival, rejections, infections, and renal function.

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