Back ground: Desensitization provides benefit in high risk kidney transplant recipients. We evaluated one year outcomes, including substances removal by apheresis techniques of ABO incompatible living donor (ABOi) and living donor with pre-transplant DSA (lvDSA), defined by positive solid phase binding assay /negative CDC-AHG compared to pre-transplant DSA positive deceased donor transplant without desensitization (dcDSA).

Method: DFPP and/or immunoadsorption (IA) with rituximab have been used for ABOi. For lvDSA, DFPP with IVIg were mainly used for desensitization. Basiliximab and thymoglobulin were used for induction in ABOi and lvDSA groups, respectively. The maintenance immunosuppressive drugs were tacrolimus, mycophenolate, and prednisolone. Preemptive treatment for CMV was used in this study

Results: There were 18, 19, and 14 recipients in ABOi, lvDSA, and dcDSA groups, respectively. Seven of 18 ABOi recipients also had pre-transplant DSA. In ABOi, there were one (5.6%) recipients developed immediate post-op ABMR with graft loss from anti-HLA and one dead from late post-transplant stroke. There were 2 (10.5%) and 7 (50%) recipients developed ABMR in lvDSA and dcDSA, respectively (Figure 1), p < 0.05. CMV viremia was comparable between groups. Both DFPP and IA were able to decreased target antibodies. However, the serum IgG, IgA, IgM, fibrinogen and vWF were significantly decreased only by DFPP. Conclusion: Desensitization in living donor with ABOi or pre-transplant DSA is effective. IA is more specific in removing the target antibodies. Our study support the benefit of desensitization in living kidney transplantation.

CITATION INFORMATION: Kitrungphaiboon T, Townamchai N, Saengpanit D, Iampenkhae K, Jutivorakool K, Avihingsanon Y, Praditpornsilpa K. Comparing Outcomes of ABO Incompatible to DSA Positive/CDC-AHG Negative Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

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