Histological and extended clinical outcomes following ABO-incompatible renal transplantation without splenectomy or rituximab
Publication Year 2017-06, Volume 101, Issue #6, Page 1433-1440
Journal Title
Publication Type
Journal Article
BACKGROUND: Excellent short-term results have been reported in ABO-incompatible renal transplant recipients (ABOi) managed solely with antibody removal and conventional immunosuppression. However, long-term clinical outcomes with this regimen and predictive information from protocol biopsies is lacking. METHODS: We compared outcome data in ABOi and ABO compatible (ABOc) recipients receiving this regimen approximately 4 years posttransplant, and histology from biopsies approximately 12 month posttransplant. RESULTS: Patient and graft survival amongst 54 ABOi recipients were 98.1% and 90.7% respectively at 4 years. Graft function was similar between ABOi (creatinine 140.3 mumol/L) and ABOc recipients (creatinine 140.2 mumol/L) (p=0.99), with no significant change over the study period in either group (Deltacreatinine -0.83 vs 6.6 mumol/L) (p=0.59). There was no transplant glomerulopathy (TGP) in biopsies from either group. Interstitial fibrosis and tubular atrophy (IF/TA) was present in 7/25 (28%) ABOi compared with 7/34 (20.6%) ABOc (p=0.52). Progression of IF/TA from implantation was noted in 6/25 (24%) ABOi and 6/34 (17.6%) ABOc respectively. C4d staining without antibody mediated rejection (AbMR) was present in 13/25 (52%) of early posttransplant biopsies from ABOi recipients by immunohistochemistry, but in only 4/25 (16%) at 12 months. CONCLUSIONS: ABOi performed with antibody removal and conventional immunosuppression continues to provide excellent patient and graft survival, and stable renal function over 4 years. Coupled with absent TGP and low rates of progressive IF/TA on earlier biopsies, this suggests that ABOi with conventional immunosuppression and antibody removal, without rituximab or splenectomy, can achieve long-term outcomes comparable to ABO compatible transplantation.
Wolters Kluwer
WEHI Research Division(s)
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Creation Date: 2016-08-10 04:12:51
Last Modified: 2018-07-04 03:01:19
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