AB0 incompatible kidney transplantation – first experiences

Česká verzia

Authors: Ondřej Viklický ¹; Alena Paříková ¹; Janka Slatinská ¹; Vladimír Hanzal ¹; Libuše Pagáčová ²; Eva Honsová ³; Eva Kieslichová ⁴; Libor Janoušek ⁵; Jiří Froněk ⁵
Authors place of work: Klinika nefrologie IKEM Praha, přednosta prof. MUDr. Ondřej Viklický, CSc. ¹; Pracoviště laboratorních metod IKEM Praha, přednosta prof. MUDr. Antonín Jabor, CSc. ²; Pracoviště klinické a transplantační patologie IKEM Praha, přednostka doc. MUDr. Eva Honsová, Ph. D. ³; Klinika anestezie, resuscitace a intenzivní péče IKEM Praha, přednostka MUDr. Eva Kieslichová, Ph. D. ⁴; Klinika transplantační chirurgie IKEM Praha, přednosta doc. MUDr. Jiří Froněk, Ph. D., FRCS ⁵
Published in the journal: Vnitř Lék 2015; 61(7-8): 725-730
Category: Vanýsek´s day 2015

Summary

Living donor AB0 incompatible kidney transplantation represents a new tool how to improve the access to transplantation. Majority of European protocols are based on desensitization with rituximab, triple drug immunosuppression, intravenous immunoglobulins and specific immunoadsoption (IA) which eliminates isohaemaglutinins. AB0i kidney transplant program was initiated in our centre in 2011 and 21 patients have received grafts from incompatible donors until recently. Highest accepted isohaemaglutinins titers before rituximab were 1 : 64 and corresponding pretransplant immunoadsorption procedures varied from 2 to 9. In 5 patients 1–2 IA procedures were performed also after transplantation. With the advent of paired exchange program the AB0i transplantation is offered to patients with unsuccessful matching run or with aim to improve HLA match between donor and recipient. The main complications were postoperative bleeding and urinary tract infections in patients at risk. Majority of protocol biopsies exhibited positivity of C4d staining. Neither graft loss nor patient death were noticed.

Key words:
AB0 incompatibility – glycosorb – immunoadsorption – kidney transplantation

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