From May 2023 to March 2024, the first 11 kidney transplantations from an ABO-incompatible living related donor were performed in the kidney transplantation and rehabilitation department of our institute. All recipients were young (from 28 to 50 years old), had different initial titers of antiAB0 antibodies (but they did not exceed 1:32), and the cross-match result in the lymphocytotoxic test (LTT) was negative in 10 cases, in one case the initial the result was positive. The donors were brothers and sisters of the recipients. All recipients before and after transplantation received the same three-component immunosuppressive therapy: the calcineurin inhibitor tacrolimus (Prograf/Adport) + mycophenolic acid preparations (mycophenolate mofetil (Selcept) or sodium mycophenolate (Mayfortic)) + methylprednisolone. Also, to induce immunosuppression, 4 patients were administered basiliximab at a dose of 20 mg and methylprednisolone at a dose of 1000 mg twice before transplant reperfusion.
The test was performed before rituximab administration, before surgery, and for 7 days after surgery.
Immunosuppressive therapy began two weeks before surgery and included: tacrolimus at a starting dose of 0.2 mg/kg body weight per day, followed by its correction until the target drug concentration in the blood is 15–20 ng/ml, mycophenolate mofetil 1000 mg/day).. Sessions in the amount of 3 to 5 were carried out every other day until the target anti-A/B antibody titer of 1:4 was achieved. The last preoperative session was completed with the administration of intravenous immunoglobulin according to the schedule. Desensitizing therapy (rituximab + plasma exchange + large doses of immunoglobulin), which was carried out in the preoperative period, turned out to be effective. In all patients, after the administration of rituximab, a planned decrease in B-lymphocytes was obtained. The titer of anti-A/B antibodies was reduced to a level of 1:4 using plasma exchange, which required 3 to 5 sessions. The initial function of the transplanted kidney was satisfactory and was accompanied by a fairly high diuresis and a decrease in blood creatinine to a level of less than 150 µmol/l in two recipients before the end of the first postoperative week, one until the end of the second week, and another until the end of the third week. Two recipients had to undergo multiple sessions of hemodialysis after transplantation.
During the first three weeks after surgery in 8 recipients, we observed a trend towards a decrease in the number of agglutinins to the level of 1:2 and abs.
Considering the fact that operations of this kind were carried out for the first time in Uzbekistan, we decided to perform immunosorption in one case in a patient with a titer of anti-A/B antibodies of 1:16. Among non-immune complications in recipients, in three cases there were episodes of lymphorrhea, which were successfully treated with a course of antibiotic therapy.