Aim: Renal transplantation is the treatment of choice among the present modalities available for the End Stage Kidney disease patients. However,  about a third of the donors have been traditionally considered ineligible due to there being a HLA or ABO incompatibility. However, with modern preconditioning techniques, ABO incompatible transplantation can be a viable option for the patient with near comparable outcomes in terms of graft survival, quality of life with an expected higher rate of infections and acute rejections. We present our single centre experience of the first 160 ABO incompatible kidney transplants under resource limited settings.
Material and Methods: This is a single centre retrospective study of the first consecutive 160 renal transplants done at our centre and having at least 3 months of follow up as of March 2024.
Results: Since the time of the first ABO incompatible transplant being performed (Dec 2016), a total of 183 ABO incompatible transplants have been done at our centre (upto March 2024). We have included the analysis from the first 160 consecutive pairs (till 16 Dec 2023).  Mean recipient age was 36.88. Modality of Dialysis was most commonly in-centre Hemodialysis. Median baseline anti-group titre was 128. Most common recipient blood group was O. All patients received 200 mg Rituximab at approximately 2 weeks prior to transplant. Conventional plasmapheresis was the predominant modality used for desensitisation with median 4 sessions being done before transplantation. Most common induction agent was Basiliximab 20 mg -day 0 and 4. Patient and death censored graft survival was 92 % and 89 % respectively . Biopsy proven acute rejection requiring major intervention was 4.37 % (7 patients). 2 pts developed acute antibody mediated rejection leading to graft loss in the first week after transplant. Major infection rates were 13.12 %, most common being Urinary Tract and Respiratory infections.
Conclusion: ABO incompatible transplantation can be an acceptable modality for renal transplantation in patients as compared to dialysis.With modern preconditioning techniques , even in resource limited settings, it has the potential to give results almost as good as ABO matched transplants.