ABO-incompatible renal transplantation in developing world - crossing the immunological (and mental) barrier

P, Jha; Bansal, SB; Sethi, SK; Jain, Manish; Sharma, Reetesh; Nandwani, Ashish; Phanish, Mysore K.; Duggal, Rajan; Tiwari, Angad; Ghosh, Prasun; Ahlawat, Rajesh; Kher, Vijay

doi:10.4103/0971-4065.159557

Cited by 24 publications

(18 citation statements)

References 25 publications

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“…India has seen a tremendous rise in the number of ABO incompatible transplants being performed. But, the authors could not find a convincing reference for desensitization therapy from the Indian subcontinent except a case series of three patients . The number of cases discussed in the present study is probably the largest follow‐up case series from a country with only related living donor transplants.…”

Section: Discussionmentioning

confidence: 63%

“…But, the authors could not find a convincing reference for desensitization therapy from the Indian subcontinent except a case series of three patients. 25,[30][31][32][33] The number of cases discussed in the present study is probably the largest follow-up case series from a country with only related living donor transplants. In a country like India, where many social and intellectual barriers against the organ donation prevail, deceased donor kidney transplant still remains a big challenge.…”

Section: Discussionmentioning

confidence: 99%

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Renal transplantation in HLA sensitized patients: Traversing the immunological barrier

et al. 2020

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Successful renal transplantation across HLA barrier in sensitized individuals has been on the rise during the past decade, primarily due to improved desensitization regimes. The aim of this study was to share outcome of desensitization in renal transplant recipients with donor‐specific anti‐HLA antibodies (DSA). This was a retrospective analysis of all HLA immunized individuals who were prospective renal transplant recipients. All such patients underwent preconditioning as per the institutional desensitization protocol. Complement‐dependent cytoxicity‐based crossmatch (CDC‐XM), luminex‐based crossmatch (LM‐XM) and flowcytometry‐based crossmatch (FC‐XM) were done in all cases. If any of these tests turned out positive, single antigen bead assay (SAB) was performed. Desensitization for DSA was performed in 55 patients and all patients were followed‐up for 1 year to assess graft function and patient outcome. CDC‐XM being a less sensitive assay, could not detect incompatibility in 29 (52.73%) cases. After desensitization, even though SAB and LM‐XM results revealed an MFI within acceptable range, FC‐XM being an extremely sensitive assay, continued to give a positive result in eight (14.55%) cases. The mean ± SD number of pretransplant TPE were 3.44 ± 0.98 (2‐11). Out of 55, there were 10 patients who were lost to follow up. Patient and graft survival of 45 patients at 1 year was found to be 100%. Preconditioning for renal transplants in the form of immunosuppression with TPE is an extremely useful auxiliary for transplantation in HLA sensitized renal transplant recipients.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Renal transplantation in HLA sensitized patients: Traversing the immunological barrier

et al. 2020

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“…Authors' institute was one of the first centers in India to report successful ABO-incompatible renal transplant. [ 18 19 ] The possibility of finding a live-related donor that could be HLA-matched but ABO-incompatible was explored but did not work out for these three patients. Therefore, HLA desensitization was planned and executed with all stakeholders; patient, donor, nephrologist, urologist, laboratory specialist, and transfusion medicine specialist agreeing to the plan.…”

Section: Discussionmentioning

confidence: 99%

Successful renal transplantation across HLA barrier: Report from India

et al. 2017

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Organ donors are sometimes found “unsuitable” due to the presence of donor-specific anti-HLA antibodies in the recipient. In recent years, improved desensitization protocols have successfully helped to overcome HLA incompatibility hurdle. We present three cases where optimum desensitization was achieved in patients with the donor-specific anti-HLA antibody (DSA) leading to successful renal transplantation. All patient–donor pair underwent HLA typing, complement dependent cytotoxicity crossmatch (CDC-XM), flow cytometry XM (FC-XM), and panel reactive antibody. If any of the three tests was positive, single antigen bead assay was performed to determine the specificity of the anti-HLA antibody (s). Patients with DSA were offered organ-swap or anti-HLA antibody desensitization followed by transplantation. Desensitization protocol consisted of single dose rituximab and cascade plasmapheresis (CP) along with standard triple immunosuppression. The target DSA mean fluorescence index (MFI) was <500, along with negative CDC-XM and FC-XM for both T- and B-cells. Three patients with anti-HLA DSA, who did not find a suitable match in organ swap program, consented to anti-HLA antibody desensitization, followed by transplantation. Mean pre-desensitization antibody MFI was 1740 (1422–2280). Mean number of CP required to achieve the target MFI was 2.3 (2–3). All the three patients are on regular follow-up and have normal renal function test at a mean follow-up of 8 months. This report underlines successful application of desensitization protocol leading to successful HLA-antibody incompatible renal transplants and their continued normal renal functions.

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“…We started our ABO incompatible kidney transplantation in 2010 and reported the short term outcome in 13 patients with loss of graft in 2 due to antibody mediated rejections [12]. Similarly, Virani et al [13] and P. K. Jha et al [14] have reported a successful short term outcome from Mumbai and Delhi. The present study is an analysis of the data of patients who have crossed 12 months post successful ABO incompatible kidney transplantation up to a period of 66 months with special reference to kidney function and infections.…”

Section: Introductionmentioning

confidence: 99%

Long Term Follow-Up of ABO Incompatible Kidney Transplantation—A Study from India

Rajan¹,

Kannan²

2016

OALib

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Background: There is a need to do ABO incompatible kidney transplantation in a country like India where deceased donor transplantation is not common. More than 90% transplantations are done with living donors. Although short term results have been reported from 4 centers, there is paucity of data on long term follow-up of such patients. Methods: The data of 18 patients who had undergone ABO incompatible transplantation exceeding a follow-up of 12 months up to 66 months were analyzed. It was compared with the data of compatible kidney transplantation during the same period. Results: In both the groups, there was a similar incidence of urinary tract infection and gastroenteritis with complete recovery. Tuberculosis was successfully treated in 2 patients who had undergone ABO incompatible transplantation. The graft function was excellent with an average follow-up period of 38.2 months. There was no patient mortality during the follow-up period. Conclusion: The long term outcome of ABO incompatible kidney transplantation is similar to compatible kidney transplantation despite the increased incidence of short term complications.

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ABO-incompatible renal transplantation in developing world - crossing the immunological (and mental) barrier

Cited by 24 publications

References 25 publications

Renal transplantation in HLA sensitized patients: Traversing the immunological barrier

Renal transplantation in HLA sensitized patients: Traversing the immunological barrier

Successful renal transplantation across HLA barrier: Report from India

Long Term Follow-Up of ABO Incompatible Kidney Transplantation—A Study from India

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