Authors: (including presenting author): :
MKM Ma(1), JSY Kwok(2), GYY Hwang(1), JHL Tsu(3), R Leung(4), G Chan(5), BY Choy(1), SCW Tang(1), TM Chan(1)
Affiliation: :
(1) Department of Medicine, (2) Division of Transplantation & Immunogenetics, Department of Pathology, (3) Department of Surgery, (4) Division of Haematology, Department of Pathology, (5) Division of Anatomical Pathology, Department of Pathology, Queen Mary Hospital
Introduction: :
Over 2000 patients with end-stage kidney failure (ESKD) are waiting for kidney transplantation, and many die from complications of chronic kidney disease while waiting. Desensitization and Paired Kidney Donation (PKD) are two strategies to overcome immunological barriers caused by blood group or HLA incompatibility. The first case of ABO-incompatible kidney transplantation was performed at QMH in 2017. To date, the patient has been followed for 44 months, with no major complication. Here we report the first case of successful HLA-incompatible and ABO-incompatible kidney transplantation in 2020 in Hong Kong with desensitization preconditioning.
Objectives: :
Overcoming immunological barriers increases the kidney transplantation rate and improves the survival of ESKD patients.
Methodology: :
The present case is a 48-year old lady with kidney failure due to IgA nephropathy. Her blood group is B+, while her husband (kidney donor) is blood group A+. In addition, the kidney recipient had donor-specific anti-DQ9 antibody, likely due to prior pregnancy sensitization, that led to positive allo-T-cell flow cytometry crossmatch. The couple turned down the option of waiting for a HLA and blood group matched kidney through the PKD programme, and proceeded with desensitization followed by kidney transplantation, which was performed in July 2020. She has remained well with stable graft function and no anti-HLA antibody post-transplantation. Protocol allograft biopsy at three months post-transplant showed C4d staining without evidence of rejection.
Result & Outcome: :
Our results show that in carefully selected patients, pre-operative desensitization can be an effective means to overcome immunological barriers due to ABO-incompatibility and/or HLA-incompatibility, and facilitate kidney transplantation. While PKD may be preferred in ESKD patients who may be relatively ‘easy to match’ (e.g. blood group A kidney donor to B recipient, or B to A), desensitization with or without PKD would be more appropriate for ESKD patients who are likely ‘difficult to match’ (e.g. blood group O).
