Trasplante renal de donante vivo ABO incompatible. Estudio de 48 pacientes tras desensibilización / ABO-incompatible living-donor kidney transplantation: Study of 48 patients after desensitisation

ANTECEDENTES: El trasplante renal de donante vivo ABO incompatible era considerado una contraindicación absoluta. Desde hace años, se realiza con buenos resultados. OBJETIVO: Nuestro objetivo es mostrar los resultados de este tipo de trasplante realizado en nuestro hospital. MÉTODOS: Estudiamos 48 pacientes con una edad media de 50,9 ± 10,9 años. Seguimiento 44,6 ± 30,9 meses. Acondicionamiento: rituximab 375mg/m2, tacrolimus, micofenolato mofetilo o micofenolato sódico, prednisona, plasmaféresis/inmunoadsorción e inmunoglobulina intravenosa. Títulos de isoaglutininas aceptados para trasplantar: IgG e IgM inferiores a 1:8. RESULTADOS: Isoaglutininas preproceso: IgG 1:124 ± 1:140, IgM 1:77 ± 1:55. Tras 6 ± 3 sesiones, la IgG descendió a < 1:8 en 47 pacientes, a<1:16 en uno; la IgM fue < 1:8 en todos. Veinticuatro pacientes (50%) presentaron hematoma, 7 reintervención (14,6%) y 29 (60%) necesitaron transfusión. Al quinto año presentaron rechazo agudo 5 pacientes (8,7%), CMV 9 (19,7%), viremia BK 5 (12,4%), diabetes postrasplante 10 (23,4%), linfocele 3 (6,4%). La supervivencia del paciente fue del 97,1% al quinto año y la del injerto, del 95,7% al año y del 93% al quinto año. Pérdida de injerto: trombosis (n = 1), rechazo mixto (n = 1) y exitus (n=2). La creatinina al año y a los 3 años fue de 1,4 ± 0,4 mg/dl y de 1,3 ± 0.3 mg/dl al quinto año. La proteinuria al año, a los 3 y a los 5 fue de 0,2 ± 0,2 g/24 h. CONCLUSIONES: El trasplante renal de donante vivo ABO incompatible tras acondicionamiento con rituximab, plasmaféresis/inmunoadsorción e inmunoglobulinas es una opción válida y ofrece excelentes resultados de supervivencia, con una baja incidencia de rechazo agudo sin aumento de complicaciones infecciosas. Se evidencia una mayor tendencia al sangrado postoperatorio

BACKGROUND: ABO-incompatible living-donor kidney transplantation was regarded as an absolute contraindication. However, it has been carried out for years with good outcomes. OBJECTIVE: Our aim was to show the results obtained with this technique in our hospital. METHODS: Forty-eight patients with a mean age of 50.9 ± 10.9 years were included. Follow-up was 44.6 ± 30.9 months. Conditioning: rituximab 375 mg/m2, tacrolimus, mycophenolate mofetil or mycophenolate sodium, prednisone, plasmapheresis/immunoadsorption and intravenous immunoglobulin. Accepted IgG and IgM titres for transplantation: < 1:8. RESULTS: Pre-process IgG titre 1:124 ± 1:140, IgM titre 1:77 ± 1:55. After 6 ± 3 sessions, IgG decreased to < 1:8 in 47 patients and to < 1:16 in one. IgM was < 1:8 in all cases. Twenty-four patients (50%) had haematoma, 7 re-intervention (14.6%), 29 (60%) required transfusion. At 5 years, acute rejection had occurred in 5 cases (8.7%), CMV infection in 9 (19.7%), BK viraemia in 5 (12.4%), post-transplant diabetes in 10 (23.4%) and lymphocele in 3 (6.4%). Patient survival was 97.1% at 5 years and graft survival 95.7% at one year and 93% at 5 years. Causes of graft loss: thrombosis (n = 1); mixed rejection (n = 1); and death (n = 2). Serum creatinine levels were 1.4 ± 0.4 mg/dl at one and 3 years and 1.3 ± 0.3 mg/dl at 5 years. Proteinuria was 0.2 ± 0.2 g/24 h at one, 3 and 5 years. CONCLUSIONS: ABO-incompatible living-donor kidney transplantation after conditioning with rituximab, plasmapheresis/immunoadsorption and immunoglobulins is a valid option offering excellent outcomes. There is a low incidence of acute rejection and no increase in infectious complications. An increased tendency for postoperative bleeding was found

ABO-incompatible living-donor kidney transplantation: Study of 48 patients after desensitisation. / Trasplante renal de donante vivo ABO incompatible. Estudio de 48 pacientes tras desensibilización.

BACKGROUND: ABO-incompatible living-donor kidney transplantation was regarded as an absolute contraindication. However, it has been carried out for years with good outcomes. OBJECTIVE: Our aim was to show the results obtained with this technique in our hospital. METHODS: Forty-eight patients with a mean age of 50.9±10.9 years were included. Follow-up was 44.6±30.9 months. Conditioning: rituximab 375mg/m2, tacrolimus, mycophenolate mofetil or mycophenolate sodium, prednisone, plasmapheresis/immunoadsorption and intravenous immunoglobulin. Accepted IgG and IgM titres for transplantation:<1:8. RESULTS: Pre-process IgG titre 1:124±1:140, IgM titre 1:77±1:55. After 6±3 sessions, IgG decreased to<1:8 in 47 patients and to<1:16 in one. IgM was<1:8 in all cases. Twenty-four patients (50%) had haematoma, 7 re-intervention (14.6%), 29 (60%) required transfusion. At 5 years, acute rejection had occurred in 5 cases (8.7%), CMV infection in 9 (19.7%), BK viraemia in 5 (12.4%), post-transplant diabetes in 10 (23.4%) and lymphocele in 3 (6.4%). Patient survival was 97.1% at 5 years and graft survival 95.7% at one year and 93% at 5 years. Causes of graft loss: thrombosis (n=1); mixed rejection (n=1); and death (n=2). Serum creatinine levels were 1.4±0.4mg/dl at one and 3 years and 1.3±0.3mg/dl at 5 years. Proteinuria was 0.2±0.2g/24h at one, 3 and 5 years. CONCLUSIONS: ABO-incompatible living-donor kidney transplantation after conditioning with rituximab, plasmapheresis/immunoadsorption and immunoglobulins is a valid option offering excellent outcomes. There is a low incidence of acute rejection and no increase in infectious complications. An increased tendency for postoperative bleeding was found.

Successful treatment of pure red cell aplasia with high-dose dexamethasone after ABO-incompatible allogeneic hematopoietic stem cell transplantation.

The literature reports an incidence of Pure Red Cell Aplasia (PRCA) ranging from 6-30% of all cases of ABO-incompatible HSCT. Although most patients resolve spontaneously after withdrawal immunosuppression, some of them require more aggressive treatment to manage this condition.