Introduction: ABO-incompatible (ABOi) and HLA-incompatible (HLAi) kidney transplantation using living donors is common place; however, few data have reported on the outcomes of ABOi/HLAi living-kidney transplantation.

Methodology: Herein, we report on a single-center experience of 12 ABOi/HLAi living-kidney patients (seven females), of which 9 were from group A into O. There were 27 donor-specific alloantibodies (DSAs) (1–6 per patient) with fluorescence intensities ranging from 1,500–15,000. The desensitization protocol was based on IV-Ig (1 g/kg on day-40 pretransplant), rituximab 375 mg/m² (days 30 and 15 pretransplant), tacrolimus(0.2 mg/kg)-based immunosuppression, started on day-10 pretransplant, and apheresis sessions (plasmapheresis, specific or semi-specific immunoadsorption). Patients had a mean of 11 (6–27) pretransplant sessions.

Results: On day 0, 17 of the 27 DSAs were no longer detectable; DSAs >3,000 were observed in only three patients. After 19 (3–51) months, patient- and graft-survival rates were 100% and 91.6%, respectively. One graft was lost due to renal-vein thrombosis. No patient had an acute cellular or humoral rejection, whereas three presented with chronic antibody-mediated rejection. At the last follow-up, kidney biopsies were nearly normal in seven cases (58.3%) and renal function was excellent except for two cases of chronic antibody-mediated rejection. One patient developed cytomegalovirus disease, four had BKV infection, and five had pyelonephritis.

Conclusion: We conclude that ABOi/HLAi living kidney transplantation is a reasonable option for highly sensitized patients who have limited access to kidney transplantation.

CITATION INFORMATION: Rostaing L, Congy N, Allal A, Esposito L, Sallusto F, Congy N, Doumerc X, Debiol B, Kamar N. Successful Transplantation in ABO- and HLA-Incompatible Kidney-Transplant Patients. Am J Transplant. 2016;16 (suppl 3).

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