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ORIGINAL RESEARCH article

Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1504495

Outcomes of ABO-Incompatible Kidney Transplants with Very High Isoagglutinin Titers: A Single-Center Experience and Literature Review

Provisionally accepted
Hamza Naciri Bennani Hamza Naciri Bennani 1Kadiatou Mamadou Bobo Barry Kadiatou Mamadou Bobo Barry 1Johan Noble Johan Noble 1Paolo Malvezzi Paolo Malvezzi 1Thomas Jouve Thomas Jouve 1Lionel PE Rostaing Lionel PE Rostaing 1,2*
  • 1 Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, Centre Hospitalier Universitaire de Grenoble, Grenoble, Rhône-Alpes, France
  • 2 Faculté de Médecine, Faculty of Humanities, Health, Sport and Society. Université Grenoble Alpes, Saint Martin d'Hères, France

The final, formatted version of the article will be published soon.

    Background: ABO-incompatible kidney transplantation (ABOi-KTx) represents a possible solution to address the shortage of kidney donors. However, these transplants present immunological challenges, particularly when isoagglutinin titers are elevated pretransplant.Methods: single-center retrospective study describing clinical and biological outcomes of 8 patients who underwent ABOi-KTx with initial isoagglutinin titers ≥ 1/512. All patients followed a desensitization protocol combining immunosuppression (rituximab, tacrolimus, mycophenolate mofetil, steroids), and specific or semi-specific apheresis sessions. Clinical and biological data were extracted from electronic medical records. There were 5 males; median age of 62 years [34-82 years]; all achieved an isoagglutinin titer of ≤1/8 before transplantation after a median of 13 (range: 9-15) apheresis sessions. Three patients (37%) experienced acute humoral rejection, which required additional plasmapheresis sessions. Two patients developed chronic active rejection, successfully treated. On the infectious side, three patients developed BK-virus reactivation. Two patients developed cytomegalovirus viremia, and two others presented with bacterial infections. Surgically, two patients developed a lymphocele, and one had a perirenal hematoma. All patients survived the transplant with stable renal function: mean serum creatinine was 138±15 µmol/L after four years of follow-up.ABO-incompatible kidney transplantation, even in patients with high isoagglutinin titers, is feasible and can achieve favourable long-term graft and patient survival outcomes. However, these procedures require substantial clinical expertise and close follow-up to monitor and manage the elevated risks of infection and rejection in this population.

    Keywords: Kidney Transplantation, isoagglutinins, ABO incompatible transplant, Desensitization, apheresis, Antibody-mediated Rejection

    Received: 30 Sep 2024; Accepted: 13 Nov 2024.

    Copyright: © 2024 Bennani, Bobo Barry, Noble, Malvezzi, Jouve and Rostaing. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Lionel PE Rostaing, Faculté de Médecine, Faculty of Humanities, Health, Sport and Society. Université Grenoble Alpes, Saint Martin d'Hères, France

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