Results from an australian national ABO incompatible (ABOi) renal transplant collaborative group.

Introduction: A collaborative group of eight Transplant Units in Australia defined a protocol for ABOi kidney transplants in an attempt to standardise therapy and collect prospective data. Method(s): Forty-two ABOi transplants were performed. Blood group titres were predominantly measured by gelcard (alternative method used in 5 cases) and the protocol allowed for Glycorex columns or plasma-exchange to reduce titres to <1:8. All but 2 recipients received Rituximab pre-transplantation, all commenced Mycophenolate and received IVIG 0.5g/kg pre transplant, with Tacrolimus based maintenance immunosuppression. Result(s): Baseline ABO titres ranged from 1:1024 to 1:1. At median follow-up of 14 months (range 1-36), patient survival was 95%, death censored graft survival was 93% and median creatinine was 121umol/l (range 82-175). There were 4 episodes of cellular rejection plus 4 cases of antibody mediated rejection (AbMR), one of which caused graft loss. One graft was lost to chronic transplant glomerulopathy and one to thrombosis, neither of these were thought to relate to ABOi AbMR. There were two deaths from pulmonary Aspergillosis, in males aged 67 and 73 at month 2 and 3 respectively. Other significant complications included haemorrhage requiring transfusion, BK nephropathy (n=2), Mycobacterium haemophilum cellulitis and pulmonary Cryptococcus and Streptococcus pneumonia. Conclusion(s): Our uncontrolled series of ABOi transplants was associated with an increased incidence of graft loss and serious infections compared to routine kidney transplantation. Components of the protocol may be implicated in some of these outcomes which highlights the need for controlled data.