Kevin V Chow1, Shaun M Flint, Angeline Shen, Anthony Landgren, Moira Finlay, Anand Murugasu, Rosemary Masterson, Peter Hughes, Solomon J Cohney. 1. 1 Department of Nephrology, Royal Melbourne Hospital, Victoria, Australia. 2 Department of Medical Biology, University of Melbourne, Victoria, Australia. 3 Division of Immunology, Walter and Eliza Hall Institute of Medical Research, Victoria, Australia. 4 Department Anatomical Pathology, Royal Melbourne Hospital, Victoria, Australia. 5 Department of Medicine, University of Melbourne, Victoria, Australia 6 Department of Nephrology, Western Hospital, Victoria, Australia.
Abstract
BACKGROUND: Excellent short-term results have been reported in ABO-incompatible (ABOi) renal transplant recipients managed solely with antibody removal and conventional immunosuppression. However, long-term clinical outcomes with this regimen and predictive information from protocol biopsies are 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 months posttransplant. RESULTS: Patient and graft survivals among 54 ABOi recipients were 98.1% and 90.7%, respectively, at 4 years. Graft function was similar between ABOi (creatinine, 140.3 μmol/L) and ABOc recipients (creatinine, 140.2 μmol/L) (P = 0.99), with no significant change over the study period in either group (Δcreatinine, -0.83 vs 6.6 μmol/L) (P = 0.59). There was no transplant glomerulopathy in biopsies from either group. Interstitial fibrosis (IF) and tubular atrophy (TA) was present in 7 (28%) of 25 ABOi compared with 7 (20.6%) of 34 ABOc (P = 0.52). Progression of IF/TA from implantation was noted in 6 (24%) of 25 ABOi and 6 (17.6%) of 34 ABOc, respectively. C4d staining without antibody-mediated rejection was present in 13 (52%) 25 early posttransplant biopsies from ABOi recipients by immunohistochemistry, but in only 4 (16%) of 25 at 12 months. CONCLUSIONS: ABO-incompatible renal transplant 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 transplant glomerulopathy 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.
BACKGROUND: Excellent short-term results have been reported in ABO-incompatible (ABOi) renal transplant recipients managed solely with antibody removal and conventional immunosuppression. However, long-term clinical outcomes with this regimen and predictive information from protocol biopsies are 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 months posttransplant. RESULTS:Patient and graft survivals among 54 ABOi recipients were 98.1% and 90.7%, respectively, at 4 years. Graft function was similar between ABOi (creatinine, 140.3 μmol/L) and ABOc recipients (creatinine, 140.2 μmol/L) (P = 0.99), with no significant change over the study period in either group (Δcreatinine, -0.83 vs 6.6 μmol/L) (P = 0.59). There was no transplant glomerulopathy in biopsies from either group. Interstitial fibrosis (IF) and tubular atrophy (TA) was present in 7 (28%) of 25 ABOi compared with 7 (20.6%) of 34 ABOc (P = 0.52). Progression of IF/TA from implantation was noted in 6 (24%) of 25 ABOi and 6 (17.6%) of 34 ABOc, respectively. C4d staining without antibody-mediated rejection was present in 13 (52%) 25 early posttransplant biopsies from ABOi recipients by immunohistochemistry, but in only 4 (16%) of 25 at 12 months. CONCLUSIONS:ABO-incompatible renal transplant 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 transplant glomerulopathy 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.
Authors: Laura Pankhurst; Alex Hudson; Lisa Mumford; Michelle Willicombe; Jack Galliford; Olivia Shaw; Raj Thuraisingham; Carmelo Puliatti; David Talbot; Sian Griffin; Nicholas Torpey; Simon Ball; Brendan Clark; David Briggs; Susan V Fuggle; Robert M Higgins Journal: Transplant Direct Date: 2017-06-26
Authors: Yorg Azzi; Gayatri Nair; Pablo Loarte-Campos; Maria Ajaimy; Jay Graham; Luz Liriano-Ward; Cindy Pynadath; Joan Uehlinger; Michael Parides; Alesa Campbell; Adriana Colovai; Omar Alani; Marie Le; Stuart Greenstein; Milan Kinkhabwala; Juan Rocca; Enver Akalin Journal: Transplant Direct Date: 2021-01-26