Experiences of performing ABO-incompatible kidney transplantation in Bangladesh

Abstract

Background:The number of end-stage renal disease (ESRD) patients is increasing in Bangladesh. Currently, living kidney donation is the only viable option for transplantation in Bangladesh, and it is further restricted by ABO compatibility issues. We have performed ABO-incompatible kidney transplantations (ABOi KTs) in Bangladesh since 2018. This study examines our experiences with seven cases of ABOi KT. Methods: The desensitization protocol included low-dose rituximab (100 mg/body) followed by plasma exchange (PEX), which was followed by a 5-g dose of intravenous immunoglobulin. Immunosuppression was undertaken using tacrolimus (0.1 mg/kg/day), mycophenolate mofetil (1,500 mg/day), and prednisolone (0.5 mg/kg/day). All patients received basiliximab for induction therapy. Results:The median baseline anti-ABO antibody titer was 1:64 (range, 1:32-1:128).Transplantation was performed at a titer of ≤1:8. Our patients attended three to five PEX sessions before transplantation. Graft survival was 100% in the seven cases over a mean period of 22 months. The mean creatinine level was 204.6±47.4 μmol/L. Two patients were suspected of having developed acute rejection and received intravenous methylprednisolone, resulting in improved kidney function. One patient required posttransplant hemodialysis due to delayed graft function and subsequently improved. Infection was the most common complication experienced by ABOi KT patients. Two patients developed severe cytomegalovirus pneumonia and died with functioning grafts. Conclusions: ABOi KT in Bangladesh will substantially expand the living kidney donor pool and bring hope to a large number of ESRD patients without ABO-compatible donors. However, the high cost and risk of acute rejection and infection remain major concerns.

A Multicenter Retrospective Cohort Study on Management Protocols and Clinical Outcomes After ABO-incompatible Kidney Transplantation in India

“…Table 1 summarizes the baseline characteristics of all ABOiKT procedures performed in this study along with a stratified analysis based on the various ABOiKT protocols used. The median age (interquartile range) of the recipients and donors at the time of ABOiKT was 40 (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)…”

“…Strikingly, all major reports, including national studies of ABOiKT, have originated from the developed world [16][17][18][19][20][21][22][23][24][25][26] with only a few small case series from India [27][28][29][30][31][32][33][34][35][36] and the developing world. [37][38][39] Here, we present a multicenter study aimed at assessing desensitization protocols, complications, and outcomes of ABOiKT that shares details on the approach and potential of ABOiKT, including plausible future modifications when applied in emerging countries.…”

“…Strikingly, all major reports, including national studies of ABOiKT, have originated from the developed world 16-26 with only a few small case series from India 27-36 and the developing world. 37-39…”