Desensitization for ABO incompatible kidney transplantation: Experience of a single center in Brazil. ABO incompatible kidney transplantation

Introduction: About 25% of the living donors analyzed for kidney donation are ABO incompatible, but ABO incompatibility can be successfully overcome by using various desensitization protocols. Data have been published on incompatible ABO transplants in Asia, Europe and North America. Brazilian data on this subject is not yet available and there is always a concern whether patients from developing countries would be more prone to rejection and infection specially when submitted to more intense immunosuppressive protocols Objective: To analyze the patient and the graft survival of the first cohort of Brazilian patients receiving ABO-incompatible transplants. Patients and Methods: From October 2012 to June 2016, we performed 10 ABO incompatible kidney transplantation (KT) procedures from a living donor. The desensitization protocol was based on rituximab and PP. All patients received induction with Thymoglobulin and long-term steroids. Tacrolimus and mycophenolate sodium were initiated at the time of desensitization and continued after the transplant. Pre-transplant agglutinin titers varied from 1/32 to 1/512. Five patients also presented anti-HLA specific antibodies, being three T and B positive FCXM at baseline. Results: After a mean follow-up of 30 ( ± 13) months, all patients are alive. One patient lost the graft due to cellular rejection that occurred after reduction of immunosuppressive therapy for an aggressive HPV-related vulvar cancer. The mean serum creatinine concentration is 1.4 ± 0.5 mg/dl. Three episodes of rejection occurred in 3 patients: two cellular and one anti-HLA mediated. Conclusion: Desensitization with Rituximab and PP allowed us to perform transplants from living donors to ABO incompatible recipients in a Brazilian population with good results, even in highly-sensitized patients and in those presenting high anti-ABO agglutinin titers