Successful ABO i Renal Transplantation in UAE
Ishthiaque Ahamed1, Venkat Vellanki1, Rehan Saif 2, Ramamurthy Ganesan 3.
1Department of Nephrology, Burjeel Medical City, Abudhabi, United Arab Emirates; 2Department of Transplant Surgery, Burjeel Medical City, Abudhabi, United Arab Emirates; 3Department of Anesthesia, Burjeel Medical City, Abudhabi, United Arab Emirates
Introduction: Renal transplantation the most effective treatment for end-stage renal disease, as it offers the best quality of life and long survival than other modalities of renal replacement therapies. Patients waiting for renal transplantation is steadily increasing globally, while the number of available kidneys is still significantly low.
Across blood group renal transplantation (ABOi; ABO incompatible) is a widely accepted modality to overcome the shortage of organs and to reduce long waiting period for renal transplantation.
Case Presentation: We describe a case of a 34-year-old female who underwent ABOi renal transplantation at our center.Recipient’s blood group is A positive and did not have a compatible donor in the family. Whilst, her husband with B positive blood group was the donor. Initially, recipient had an anti-B antibody titre of 1:32 (IgG), underwent antibody depletion with single dose of 100 mg of Rituximab injection two weeks prior to transplantation and 2 sessions of plasmapheresis just prior to transplantation. At the time of transplant anti-B titre was <1:16 (IgG). Injection Anti-thymocyte globulin rabbit was used as an induction agent.Mycophenolate and Tacrolimus was initiated four days prior to transplantation.
Patient had good urine output soon after anastomosis her graft function touched normal level on second post-operative day. During hospital stay she had mild graft dysfunction due to Klebsiella UTI, which was normalized after treatment of UTI with appropriate antibiotics. She was discharged two weeks after transplantation with normal graft function. Currently, recipient is 10 weeks post-transplant on regular follow up as an outpatient with normal graft function.
Conclusion: With better understanding of immunobiology, it has become possible to
perform ABOi renal transplantation. It is now clear that the short and long-term
outcomes of ABOi are comparable to blood group matched transplantation. The ABOi
protocol has been evolving in the last two decades with significant improvements in
patient and graft survival.
[1] ABOi transplant
