TN08THE EARLY EXPERIENCE OF ABO-INCOMPATIBLE RENAL TRANSPLANTATION IN AUSTRALIA

In the presence of static cadaveric donation rates, renal transplantation relies increasingly on living donors. ABO blood group incompatibility has traditionally prevented many potential living donors from donating because risk of hyperacute rejection/antibody-mediated rejection (AbMR) with graft loss, with or without need for concurrent splenectomy and intense immunosuppression. Pre- and post-transplant antibody removal and monitoring anti-blood group antibody levels have allowed this to become a clinical possibility. We report results on the first ten ABO incompatible kidney transplants performed in Australia at The Royal Melbourne and Melbourne Private Hospitals, without splenectomy. All patients underwent transplantation after two weeks of Mycophenolate Mofetil, and antibody removal (plasma exchanges or Glycosorb columns). Three patients received Rituximab pre-transplant. Standard immunosuppression was commenced at transplantation. All patients, except one low-titre A2/O patient, received post transplant antibody removal. None underwent splenectomy. Thirty day mortality was zero, and at median six-month follow-up, there have been no episodes of rejection or opportunistic infections. All transplants are currently functioning. Two patients developed urosepsis, one post-transplant diabetes. Two patients required reoperation and ureteric reimplantation for ureteric leakage. ABO incompatible transplantation can be performed without excessive immunosuppression and with low morbidity. Preservation of the spleen reduces operative risk, post-operative complications and the added vulnerability to infection. [PUBLICATION ABSTRACT]