Introduction:

Kidney transplantation in Sickle Cell Disease patients is fraught with complications, including increased risk of infection and thrombosis. We present long term outcomes of patients with underlying sickle cell disease following successful kidney transplantation.

Methods:

We performed ~700 kidney transplants over the last 10 years. We identified 8 kidney transplant recipients (9 kidney transplants – 1 patient received 2 transplants) who had a history of sickle cell disease or trait. We sought to describe long term patient and allograft outcomes, including: immunosuppression management, perioperative characteristics,incidence of readmissions, complications, patient and graft survival

Results:

All of them were deceased donor recipients. 100% of the patients were African American, and 66% were female. One patient required re-transplantation. Induction was basiliximab in the early period (2007-09), but later changed to anti-thymocyte globulin (33% vs. 66%). Maintenance immunosuppression included calcineurin inhibitor (88% tacrolimus) based immunosuppression in all patients with mycophenolate as adjunctive therapy. 66% of kidney transplants received steroid maintenance immunosuppression, while the remaining 33% of cases were managed with a steroid withdrawal protocol. Length of stay following transplantation in the earlier period was 17-20 days, while our recent cohort had lengths of stay between 7-11 days. Readmissions were common; causes included infection (44%), sickle cell crises (33%), and allograft rejection (22%). Causes of graft failure included death with a functioning graft (1, secondary to fungemia), and rejection (22%). At 6 months post-transplant, 77% of transplants had eGFR > 60 mL/min and 37% had eGFR >60ml/min at 1 year. Patient survival and graft survival at 1 year is 100% and at 3 year is 80% and 60% respectively. 3 recipients who have not reached 3 year mark continue to maintain excellent graft function.

Conclusion:

Kidney transplantation can be successful in recipients with sickle cell disease/trait. Complications are common, including infection and sickle cell crisis. Appropriate immunosuppression is essential, as the group remains at risk for allograft rejection, as well as serious infections. We suggest vigilant care of such patients following kidney transplantation.

CITATION INFORMATION: Lee A., Malat G., Harhay M., Levin L., Xiao G., Guy S., Reich D., Ranganna K. Kidney Transplantation in ESKD Patients with a History of Sickle Cell Disease/Trait Am J Transplant. 2017;17 (suppl 3).

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