Excellent long-term outcomes of ABO-incompatible kidney transplantation in children

Due to profound shortage of suitable deceased allografts, much effort has been made to investigate whether successful kidney transplantation is possible across the ABO blood group barrier even for pediatric recipients. Methods: Twenty-five pediatric patients underwent ABO-incompatible living kidney transplantation. All patients received three sessions of plasmapheresis (PP) or immunoadsorption (IA) to remove the anti-A/B antibodies before transplantation. This was followed by splenectomy and a conventional quadruple drug immunosuppressive protocol. To prevent overwhelming postsplenectomy infections, penicillin prophylaxis as well as pretransplant pneumococcal vaccine was given to all patients. Results: Of 25 patients, 12 grafts had rebound increases in their anti-A/B isoagglutinin titers within 10 days posttransplant. Moreover, 10 of 12 (83%) patients developed acute rejection with the increase of isoagglutinins. One patient lost the graft because of uncontrolled delayed hyperacute rejection, while the other nine acute rejection episodes were reversed with a standard anti-rejection therapy in combination with PP/IA. Four patients had severe bacterial infectious complications after transplantation. The actuarial 1-, 5- and 10-year graft survival rates are 96%, 91% and 91%, respectively. Conclusions: With the adequate desensitization protocol, ABO-incompatible kidney transplantation is a valid alternative even for children with end stage renal disease.