1. ABO incompatible kidney transplantation: the Saudi experience
- Author
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Ihab A Ibrahim, Amira Alabassi, Khalid Almeshari, Mohamed A. Hussein, Dieter C. Broering, Yaser Shah, Tariq Ali, Ehab Hammad, Hind Alhumaidan, Jens G Brockmann, Hassan Aleid, Ibrahim Alahmadi, Hazem Elgamal, Mohamed Shoukri, and S Raza more...
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Time Factors ,Urinary system ,medicine.medical_treatment ,Population ,Saudi Arabia ,lcsh:Medicine ,Opportunistic Infections ,ABO Blood-Group System ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Immunocompromised Host ,Young Adult ,0302 clinical medicine ,Prednisone ,Risk Factors ,Internal medicine ,medicine ,Humans ,education ,Transplantation ,education.field_of_study ,Thymoglobulin ,business.industry ,lcsh:R ,Graft Survival ,Immunosuppression ,030206 dentistry ,Kidney Transplantation ,Tacrolimus ,surgical procedures, operative ,Treatment Outcome ,Nephrology ,Blood Group Incompatibility ,Histocompatibility ,Rituximab ,Female ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
Although the outcomes of ABO-incompatible (ABOi) kidney transplant recipients are quite favorable, these patients are at increased risk of early antibody-mediated rejection (AMR) and graft loss. Some studies have also shown high mortality in the ABOi group mainly due to increased risk of infections. The AMR rates have been reported anywhere from 50% in the literature. The outcomes of the ABOi kidney transplants in the Saudi population are not known. In this study, we aimed to determine the graft and patient survival in ABOi kidney transplant recipients in the Saudi population. We included all adult patients who underwent ABOi transplantation between 2007 and 2016. All patients received rituximab, therapeutic plasma exchange, thymoglobulin, intravenous antibiotics, and intravenous immunoglobulin. The maintenance immunosuppression was prednisone, mycophenolate mofetil, and tacrolimus. The data were collected from a prospectively maintained database. A total of 77 patients were included in the study. The most common blood group mismatch was A to O (44.2%), followed by B to O (26.0%) and A to B (16.9%). In the 1st year, 17% of patients developed acute cellular rejection and AMR occurred in 7.8% of patients. Two patients were diagnosed with BK nephropathy. In the 1st year, urinary tract infection occurred in 25 (32.5%) patients. No patient was diagnosed severe viral or fungal infection. In the 1st year, four grafts were lost (graft survival of 94.8%); all grafts were lost within two weeks, three due to AMR and one due to technical reason. One year patient survival was 100%. In this study of ABOi kidney transplant recipients, we observed low risks of infectious complications with excellent patient and graft survival. Our immunosuppressive protocol can be considered safe. more...
- Published
- 2019