Background:

There is significant variation in waiting times for deceased donor (DD) renal transplants based on recipient blood group. Furthermore, there is an increased discard rate for type AB DD kidneys. Historically, DD ABO-incompatible renal transplantation (ABOi) has been limited to kidneys from A2 or A2B blood group donors transplanted into group B recipients with low anti-A titres. Recent living donor ABOi into recipients with low titre anti-blood group antibody (ABGAb) across all blood group incompatibilities using standard immunosuppression alone suggests deceased donor ABOi may be possible for selected recipients with limited or no antibody removal pre-transplantation.

Methods: Two cases of deceased donor ABOi kidney transplantation from A1B donors, in the setting of low pre-transplant ABGAb titres are described. An audit of ABGAb titres of long-wait listed patients was undertaken to explore the proportion of patients that may be suitable for listing for deceased donor ABOi transplantation based on institutional thresholds used for patients receiving live donor ABOi transplants.

Results: Two DD ABOi transplants were performed at our institution from A1B donors after no suitable AB waitlisted candidates could be identified through the national organ allocation program. A 65 year old woman with blood group B and anti A titre 1:16 (by Ortho technique) underwent transplantation following a single plasma exchange with standard immunosuppression. A 50 year old man with blood group A and anti B titre 1:8 underwent transplantation without any pre-operative plasma exchange. Both patients experienced episodes of cellular rejection post-transplantation (at day 7 and 12 months, respectively) but have good graft function at 5 and 4 years (creatinine 120umol/L, eGFR 39ml/min and creatinine 85umol/L, eGFR 85ml/min, respectively). An audit of all group A and B waitlisted patients at our institution (n=157) showed 43% had anti ABO titres measured and of these, 75% had a titre of [pound]1:16, our institutional threshold for proceeding with living donor ABOi transplantation without pre-transplant plasma exchange. There was significant variability in titres for each patient when measured by three difference techniques (Ortho, Tube and Diamed).

Conclusion: DD ABOi transplantation from A1B donors is a feasible option to reduce the discard rate of A1B kidneys and increase transplantation options for a significant proportion of A and B waitlisted patients.

CITATION INFORMATION: Sypek M, Masterson R, Hughes P. ABO Incompatible Deceased Donor Renal Transplantation: Exploring the Possibilities. Am J Transplant. 2017;17 (suppl 3).

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