Desensitization strategies for ABO-incompatible living related kidney transplantation

Objective To explore the strategies of desensitization treatment for ABO incompatible (ABOi) related living-donor kidney transplantation. Methods A retrospective analysis was performed for 14 recipients undergoing ABOi related living kidney transplantation from July 2015 to December 2018. The clinical outcomes and expenditures of desensitization treatment before and after optimizing desensitization were compared. Results After desensitization treatment, 14 recipients successfully underwent ABOi-kidney transplantation. Within 2 weeks post-transplantation, blood group antibody rebounded to 1: 64 in only 1 recipient. Within 1 week post-transplantation, the serum creatinine levels decreased to 85-165 μmol/L in 14 recipients. Thirteen patients stabilized after 1 week while another patient had an elevated level of serum creatinine at Day 12 post-operation and renal allograft function recovered after treatment. Two cases of rejection were diagnosed by clinical manifestations and 1 case was confirmed by pathological biopsy. Five cases of programmed renal allograft biopsy indicated critical or suspected acute T-lymphocytic rejection within 1 year. Thirteen cases (92.6%) demonstrated varying degrees of peritubular capillary deposition of C4d. One case developed BK viral uropathy within 1 year and four patients of pulmonary infections requiring hospitalization were cured after treatment. During an early stage, the incidence of postoperative infection was 57.14% and declined to 14.29% after optimized desensitization. The expenditure of early desensitization treatment was (27004.86±10719.85) yuan and (10612.29±8143.05) yuan after optimization. And the expenditure of optimized desensitization was significantly lowered (P<0.05). During follow-ups, renal allograft function of 14 recipients remained decent. And the survival rate of recipient/allograft was 100% up to the statistical cut-off point. Conclusions Both desensitization strategies may achieve the goal of desensitization for ABOi kidney transplantation and the outcomes are excellent. The expenditure of desensitization treatment is significantly lowered after optimization. Key words: Kidney transplantation; Lving donor; ABO incompatibility; Blood group antibody; Desensitization therapy; Antibody-mediated rejection