title: Outcome of ABO-Incompatible Living Donor Renal Transplantations: A Single-Center Experience From Eastern India.
abstract: BACKGROUND
  With the incessantly increasing number of patients on the waiting list for renal transplants, crossing the blood group barrier can substantially increase the donor pool. We started ABO-incompatible (ABOi) renal transplantation in 2013 with a relatively low-cost preconditioning protocol (additional cost, ∼$1200). This study reports the short-term outcome of ABOi renal transplantations performed at our institution.
  
  
  METHODS
  A total of 45 adult ABOi kidney transplant recipients (KTRs) were included in the study. All of them underwent a pretransplantation conditioning program, which included plasmapheresis, low-dose intravenous immunoglobulin (IVIG), and low-dose rituximab. A pretransplantation isoagglutinin titer of ≤1:8 was considered acceptable for transplantation until December 2014, after which the threshold was increased to ≤1:32.
  
  
  RESULTS
  Overall, 50% of KTRs were of blood group O. The maximum initial antibody titer was 1:2048. All the patients achieved immediate graft function post-transplantation. The mean serum creatinine level at 370 days (median duration of follow-up) was 1.21 mg%. One graft was lost due to severe antibody-mediated rejection (ABMR) with cortical necrosis. The graft survival rate was 97.78% and the patient survival rate was 97.78%. The overall result in terms of graft and patient survival, infections, and rejections were similar to ABO-compatible transplantations.
  
  
  CONCLUSIONS
  ABOi renal transplantation is a cost-effective modality to increase the donor pool. Contrary to the belief that this modality is extremely expensive and requires elaborate infrastructure, we had a good short-term outcome with a relatively simple and low-cost preconditioning protocol.
authors: Department of Renal Sciences, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health Hospitals, Kolkata, India. Electronic address: deepak_ray@hotmail.com.
authors: D S
authors: DS
authors: Ray
authors: Department of Renal Sciences, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health Hospitals, Kolkata, India.
authors: S
authors: S
authors: Thukral
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D001787:Blood Group Incompatibility / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007194:India; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D000069283:Rituximab / Q000627:therapeutic use; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D000069283:Rituximab