ABO incompatible renal transplant: Transfusion medicine perspective.
BACKGROUND
Our study presents an analysis of the trends of ABO antibody titers and the TPE (Therapeutic Plasma Exchange) procedures required pre and post ABO incompatible renal transplant.


METHODS
Twenty nine patients underwent ABO incompatible renal transplant during the study period. The ABO antibody titers were done using the tube technique and titer reported was the dilution at which 1+ reaction was observed. The baseline titers of anti-A and anti-B antibodies were determined. The titer targeted was ≤8. Patients were subjected to 1 plasma volume exchange with 5% albumin and 2 units of AB group FFP (Fresh Frozen Plasma) in each sitting. TPE procedures post-transplant were decided on the basis of rising antibody titer with/ without graft dysfunction.


RESULTS
The average number of TPE procedures required was 4-5 procedures/patient in the pretransplant and 2-3/patient in the post-transplant period. An average titer reduction of 1 serial dilution/procedure was noted for Anti-A and 1.1/procedure for Anti-B. Number of procedures required to reach the target titer was not significantly different for Anti-A and Anti-B (P= 0.98). Outcome of the transplant did not differ significantly by reducing titers to a level less than 8 (P= 0.32). The difference in the Anti-A and Anti-B titers at 14th day post-transplant was found to be clinically significant (P= 0.042).


CONCLUSIONS
With an average of 4-5 TPE procedures pretransplant and 2-3 TPE procedures post transplants, ABO incompatible renal transplantations can be successfully accomplished.
Department of Transfusion Medicine and Immunohematology, Indraprastha Apollo Hospitals, New Delhi, India.
Raj Nath
RN
Makroo
Department of Transfusion Medicine and Immunohematology, Indraprastha Apollo Hospitals, New Delhi, India.
Sweta
S
Nayak
Department of Transfusion Medicine and Immunohematology, Indraprastha Apollo Hospitals, New Delhi, India.
Mohit
M
Chowdhry
Department of Nephrology, Indraprastha Apollo Hospitals, New Delhi, India.
Sanjiv
S
Jasuja
Department of Nephrology, Indraprastha Apollo Hospitals, New Delhi, India.
Gaurav
G
Sagar
Department of Transfusion Medicine and Immunohematology, Indraprastha Apollo Hospitals, New Delhi, India.
N L
NL
Rosamma
Department of Transfusion Medicine and Immunohematology, Indraprastha Apollo Hospitals, New Delhi, India.
Uday Kumar
UK
Thakur
ABO incompatible; renal; therapeutic plasma exchange; titer