ABO incompatible renal transplant: Transfusion medicine perspective

• Published in: Asian journal of transfusion science Vol. 11; no. 1; pp. 45 - 49
• Main Authors: Makroo, Raj Nath, Nayak, Sweta, Chowdhry, Mohit, Jasuja, Sanjiv, Sagar, Gaurav, Rosamma, N L, Thakur, Uday Kumar
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01-01-2017; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: ABO incompatible; Analysis; Antibodies; Kidney transplantation; Medical research; Original; Plasma exchange (Therapeutics); renal; therapeutic plasma exchange; titer; India; renal; titer; therapeutic plasma exchange; ABO incompatible
• ISSN: 0973-6247; 1998-3565
• DOI: 10.4103/0973-6247.200767

Our study presents an analysis of the trends of ABO antibody titers and the TPE (Therapeutic Plasma Exchange) procedures required pre and post ABO incompatible renal transplant.
Twenty nine patients underwent ABO incompatible renal transplant during the study period. The ABO antibody titers were done using the tube technique and titer reported was the dilution at which 1+ reaction was observed. The baseline titers of anti-A and anti-B antibodies were determined. The titer targeted was ≤8. Patients were subjected to 1 plasma volume exchange with 5% albumin and 2 units of AB group FFP (Fresh Frozen Plasma) in each sitting. TPE procedures post-transplant were decided on the basis of rising antibody titer with/ without graft dysfunction.
The average number of TPE procedures required was 4-5 procedures/patient in the pretransplant and 2-3/patient in the post-transplant period. An average titer reduction of 1 serial dilution/procedure was noted for Anti-A and 1.1/procedure for Anti-B. Number of procedures required to reach the target titer was not significantly different for Anti-A and Anti-B (
= 0.98). Outcome of the transplant did not differ significantly by reducing titers to a level less than 8 (
= 0.32). The difference in the Anti-A and Anti-B titers at 14th day post-transplant was found to be clinically significant (
= 0.042).
With an average of 4-5 TPE procedures pretransplant and 2-3 TPE procedures post transplants, ABO incompatible renal transplantations can be successfully accomplished.