Optimizing HLA matching in a highly sensitized pediatric patient using ABO-incompatible and paired exchange kidney transplantation.
BACKGROUND
Kidney transplantation is the treatment of choice for end-stage renal disease. However, since pediatric patients have long projected life-years, it is also optimal for them to get well-matched transplants to minimize long-term sensitization. In North America, pediatric kidney transplantation is largely dependent upon the use of deceased donor organs, making it challenging to identify timely, well-matched transplants. Pediatric recipients may have willing living donors who are either HLA- or ABO-incompatible (ABOi); therefore, one solution is to utilize ABOi transplants and paired exchange programs to enhance HLA matching and living donation.


METHODS
We adopted this approach for a highly sensitized patient with cPRA 90%, who received a successful ABOi paired exchange transplant. The recipient received pre-transplant immunomodulation until an acceptable isohemagglutinin titer <1:8 was reached before transplantation. The patient was induced with anti-thymocyte globulin and maintained on steroid-based triple immunosuppression. Eighteen-month allograft function is excellent with an estimated glomerular filtration rate (eGFR) of 83.53 ml/min/1.73 m(2). The patient did not develop de novo donor-specific HLA antibodies or have any episodes of acute rejection


CONCLUSIONS
This case highlights the safety and efficacy of using paired exchange in combination with ABOi transplants in pediatric kidney transplantation to optimize HLA matching, minimize wait times, and enhance allograft survival.
Department of Pediatrics, OU Childrens, University of Oklahoma Health Sciences Center, 1200 N Children's Avenue, Suite 14200, Oklahoma City, OK, 73104, USA, anjali-nayak@ouhsc.edu.
Anjali B
AB
Nayak
Robert B
RB
Ettenger
Suzanne
S
McGuire
Gerald S
GS
Lipshutz
Elaine F
EF
Reed
Jeffrey
J
Veale
Eileen W
EW
Tsai
D000017:ABO Blood-Group System; D001787:Blood Group Incompatibility / Q000276:immunology*; D002648:Child; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male
D000017:ABO Blood-Group System