Therapeutic Apheresis (TA) in ABO-incompatible kidney and liver transplantation: A single center experience of 50 patients.

BACKGROUND: ABO antigens play an important role in solid organ transplantation (SOT). Desensitization for ABO incompatibility offers patients awaiting transplant a larger donor pool. The aim of this study was to assess outcome of desensitization using the institutional pre-conditioning protocol in ABO incompatible solid organ transplants. MATERIALS AND METHODS: A retrospective analysis of ABO incompatible solid organ transplants between October 2015 and June 2018, at a tertiary healthcare center was performed. The preconditioning regimen consisted of immunosuppression and Therapeutic Apheresis (TA). Pre and post TA titers were performed, till a target titer of 8 or below was achieved; at which transplant was performed. Follow-up data till one year was analyzed. RESULTS: A total of 50 ABO incompatible SOT, including 14 liver transplants and 36 renal transplants were analysed. The median baseline anti-A and anti-B titers were 192 and 256 respectively. A total of 150 TPE procedures were performed for renal, 19 TPE and eight IA procedures (5 pre-operative and 3 intraoperative) were performed for liver transplant recipients. Five (10%) patients experienced minor adverse events. Biopsy revealed Antibody Mediated Rejection (ABMR) was observed in three cases in immediate post-transplant phase and three (6.67%) cases were seen over one year. There was one death due to transplant associated thrombotic microangiopathy. Graft survival for renal transplants was 100% and death censored graft survival for liver transplant was 100%. CONCLUSION: Despite difficulties, ABO incompatible transplants can be performed without ABMR with the use of an appropriate protocol. This article is protected by copyright. All rights reserved.