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|Title:||Histological and extended clinical outcomes following ABO-incompatible renal transplantation without splenectomy or Rituximab.|
|Epworth Authors:||Cohney, Solomon (Shlomo)|
|Other Authors:||Chow, Kevin|
|Keywords:||UroRenal, Vascular Clinical Institute, Epworth HealthCare, Victoria, Australia|
Department of Nephrology, Epworth HealthCare, Richmond, Victoria, Australia.
Department of Gastroenterology, Epworth HealthCare, Richmond, Victoria, Australia.
|Citation:||Transplantation. 2016 Aug 5. [Epub ahead of print]|
|Abstract:||BACKGROUND: Excellent short-term results have been reported in ABO-incompatible renal transplant recipients (ABOi) managed solely with antibody removal and conventional immunosuppression. However, long-term clinical outcomes with this regimen and predictive information from protocol biopsies is lacking. METHODS: We compared outcome data in ABOi and ABO compatible (ABOc) recipients receiving this regimen approximately 4 years posttransplant, and histology from biopsies approximately 12 month posttransplant. RESULTS: Patient and graft survival amongst 54 ABOi recipients were 98.1% and 90.7% respectively at 4 years. Graft function was similar between ABOi (creatinine 140.3 μmol/L) and ABOc recipients (creatinine 140.2 μmol/L) (p=0.99), with no significant change over the study period in either group (Δcreatinine -0.83 vs 6.6 μmol/L) (p=0.59). There was no transplant glomerulopathy (TGP) in biopsies from either group. Interstitial fibrosis and tubular atrophy (IF/TA) was present in 7/25 (28%) ABOi compared with 7/34 (20.6%) ABOc (p=0.52). Progression of IF/TA from implantation was noted in 6/25 (24%) ABOi and 6/34 (17.6%) ABOc respectively. C4d staining without antibody mediated rejection (AbMR) was present in 13/25 (52%) of early posttransplant biopsies from ABOi recipients by immunohistochemistry, but in only 4/25 (16%) at 12 months. CONCLUSIONS: ABOi performed with antibody removal and conventional immunosuppression continues to provide excellent patient and graft survival, and stable renal function over 4 years. Coupled with absent TGP and low rates of progressive IF/TA on earlier biopsies, this suggests that ABOi with conventional immunosuppression and antibody removal, without rituximab or splenectomy, can achieve long-term outcomes comparable to ABO compatible transplantation.|
|Affiliated Organisations:||Departments of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia.|
Departments of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia.
Departments of Medicine, University of Melbourne, Parkville, Victoria, Australia.
Division of Immunology, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.
Department of Nephrology, Western Hospital, Sunshine/Footscray, Victoria, Australia.
|Type of Clinical Study or Trial:||Comparative Study|
|Appears in Collections:||UroRenal, Vascular|
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