ABO Incompatible Kidney Transplantation Without B-cell Depletion is Associated With Increased Early Acute Rejection: A Single-Center Australian Experience

Transpl Int. 2023 Sep 20:36:11567. doi: 10.3389/ti.2023.11567. eCollection 2023.

Abstract

We performed a single-center retrospective cohort study of 66 consecutive ABO incompatible kidney transplants (ABOiKT) performed without B-cell depleting therapy. Outcomes were compared to an earlier era performed with rituximab (n = 18) and a contemporaneous cohort of ABO compatible live donor transplants (ABOcKT). Acute rejection within 3 months of transplant was significantly more common after rituximab-free ABOiKT compared to ABOiKT with rituximab (OR 8.8, p = 0.04) and ABOcKT (OR 2.9, p = 0.005) in adjusted analyses. Six recipients of rituximab-free ABOiKT experienced refractory antibody mediated rejection requiring splenectomy, and a further two incurred early graft loss with no such episodes amongst ABOiKT with rituximab or ABOcKT cohorts. Patient and graft survival were similar between groups over a median follow-up of 3.1 years. This observational evidence lends strong support to the continued inclusion of rituximab in desensitization protocols for ABOiKT.

Keywords: ABO incompatible; immunosuppression; kidney transplantation; rejection; rituximab.

MeSH terms

  • ABO Blood-Group System
  • Australia
  • Blood Group Incompatibility
  • Graft Rejection
  • Graft Survival
  • Humans
  • Immunosuppressive Agents* / therapeutic use
  • Kidney Transplantation* / methods
  • Retrospective Studies
  • Rituximab / therapeutic use
  • Treatment Outcome

Substances

  • Rituximab
  • Immunosuppressive Agents
  • ABO Blood-Group System