D LUMBAN GAOL1,2, M MARBUN1, E SUSALIT1
1Indonesia Society of Nephrology,Central, Indonesia, 2Faculty of Medicine, Universitas Indonesia / Cipto Mangunkusumo General Hospital
Introduction: ABO-incompatible kidney transplantation (ABO-iKT) has long been considered to be a high-risk procedure. The major challenge in blood group ABO-iKT is to minimize antibody-mediated rejection (AMR). The advanced in immunosuppressive therapy and desensitization techniques enable regardless of ABO-iKT. In this study, we presented our first 3 cases of ABO-iKT in Indonesia.
Case Report: We enrolled three ABO incompatibility patients. In our protocol, we started mycophenolate mofetil (2g/d), tacrolimus (8-10 mg/d) on day 7 pretransplant and added rituximab 500mg only once on day 7 pretransplant. We performed 2 until 3 sessions of therapeutic plasma exchange (TPE) with albumin replacement and administered IVIG (1 g/kg) on dialysis day. Patients received 20 mg of basiliximab on the transplantation day and day 4 after transplantation. Before transplantation anti-A/B isoagglutinin titer was below 1:32. One patient developed graft rejection because the patient had emergency red blood cell transfusion and the other two patients experienced with immediate and good graft function.
Conclusion: From our experience, kidney transplantation in ABO-iKT patients can be successfully performed using desensitization protocol start at day 7 pretransplant.
Keyword: ABO incompatible, kidney transplantation, desensitization
Donnie Lumban Gaol is a nephrology fellow at Cipto Mangunkusumo General Hospital-Faculty of Medicine University of Indonesia. His Internal Medicine Residency was at Cipto Mangunkusumo General Hospital. He had been several times awarded for best poster presentation from Indonesian Association of Nephrology (Inasn). In his clinical practice, he has interest in the care of transplantation patient, glomerular disease, and interventional nephrology.