ABO-Incompatible Living-Donor Kidney Transplantation in a Developing Country: A Multicenter Experience in Malaysia.

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  • Additional Information
    • Source:
      Publisher: Elsevier Science Inc Country of Publication: United States NLM ID: 0243532 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2623 (Electronic) Linking ISSN: 00411345 NLM ISO Abbreviation: Transplant Proc Subsets: MEDLINE
    • Publication Information:
      Publication: New York, N.Y. : Elsevier Science Inc.
      Original Publication: New York Stratton.
    • Subject Terms:
      Blood Group Incompatibility/*mortality ; Desensitization, Immunologic/*mortality ; Graft Rejection/*mortality ; Graft Survival/*immunology ; Kidney Transplantation/*mortality; Adult ; Antibodies/immunology ; Blood Group Incompatibility/immunology ; Desensitization, Immunologic/methods ; Developing Countries ; Feasibility Studies ; Female ; Graft Rejection/immunology ; Humans ; Kidney/immunology ; Kidney Transplantation/methods ; Living Donors ; Malaysia ; Male ; Middle Aged ; Survival Rate ; Treatment Outcome
    • Abstract:
      Malaysia has a low deceased-donor donation rate and has not embarked on a paired kidney exchange program; therefore, ABO-incompatible and HLA-incompatible transplantation remain the main contributor to the sustainability of the national kidney transplantation (KT) program. There were 26 cases of ABO-incompatible KTs performed from 2011 to 2018 in 3 major transplant centers, namely, Hospital Kuala Lumpur, University Malaya Medical Centre, and Prince Court Medical Centre. We collected perioperative and follow-up data through June 2019. The desensitization protocol varies and is center specific: the localized Japanese protocol and Swedish protocol with a target anti-A/B isoagglutinin titer of 16 or 32 on the day of transplant. The induction and tacrolimus-based maintenance protocol was nearly identical. The median follow-up time was 62.3 months (interquartile range, 37.0-79.7). Fifteen subjects had the highest predesensitization anti-A/B titer of ≥32 (57.7%). The acute cellular rejection and antibody-mediated rejection incidence were 12.5% (3 cases) and 8.3% (2 cases), respectively. Patient, graft, and death-censored graft survival rates were 96.2%, 92.3%, and 96.0%, respectively, 1 year post-living-donor KT (LDKT) and 96.2%, 87.2%, and 90.7%, respectively, 5 years post-LDKT. Our experience shows that ABO-incompatible LDKT using a suitable desensitization technique could be a safe and feasible choice for LDKT even with varied desensitization regimens for recipients with relatively high baseline isoagglutinin titers.
      (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)
    • Accession Number:
      0 (Antibodies)
    • Publication Date:
      Date Created: 20210125 Date Completed: 20210607 Latest Revision: 20210607
    • Publication Date:
      20240628
    • Accession Number:
      10.1016/j.transproceed.2020.10.038
    • Accession Number:
      33487455