Introduction: ABO-incompatible (ABOi) kidney transplantation presents a significant challenge due to preformed antibodies against donor blood antigens. Successful transplantation often necessitates robust preoperative desensitization to mitigate these antibodies. With the emergence of COVID-19, it is crucial to understand how these methods impact susceptibility to the virus post-transplantation. This study aims to compare the efficacy of two desensitization protocols in ABOi living kidney transplant recipients.
Methods: The outcomes of 8 ABOi living kidney transplantations were retrospectively analyzed, divided into two groups based on the preoperative desensitization regimen. Group 1 (n=6) underwent conventional immunoadsorption (IA) or plasmapheresis (PP), while Group 2 (n=2) received lymphoplasmapheresis. Anti-blood type antibody titers were assessed before and after desensitization, as well as post-transplantation, with monitoring of serum creatinine levels and immune function changes. Lastly, the incidence and severity of COVID-19 infection after transplantation were also evaluated.
Results: Both desensitization approaches effectively reduced anti-blood type antibody titers to below 16 preoperatively. Post-transplantation, only one Group 1 patient exhibited elevated antibody titers. Significant decreases in serum creatinine within the first post-transplantation month were observed in both groups (ranging from 62-179 umol/L). No notable differences in immune function were noted between the groups. Among the two patients who received lymphoplasmapheresis, one did not contract COVID-19, and the other developed a mild case with a PCR cycle threshold (Ct) value <30, indicating low viral load. Conversely, four out of six patients who underwent IA/PP developed COVID-19, presenting with more severe symptoms, including pulmonary infiltrates, and all had Ct values >30, suggesting higher viral loads.
Conclusion: This study suggests that both conventional immunoadsorption/plasma exchange and lymphoplasmapheresis are viable for preoperative desensitization in ABOi kidney transplantation. These methods successfully decrease blood type antibody levels, enhance transplantation outcomes, and maintain comparable post-transplantation renal function and immune status. Larger studies are warranted to determine the optimal desensitization strategy for ABOi kidney transplant recipients.