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G473 Outcomes of abo incompatible kidney transplantation in children
  1. J Stojanovic1,
  2. N Mamode2,
  3. A Adamusiak2,
  4. K Knapp1,
  5. C Barton3,
  6. HE Jones3,
  7. J Taylor3,
  8. SD Marks1
  1. 1Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  2. 2Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  3. 3Department of Paediatric Nephrology, Evelina London Children’s Hospital, London, UK

Abstract

Objective ABO blood group incompatible transplantation (ABOi) has become increasingly common over the last decade, in part due to a shortage of suitable deceased donor allografts. Whilst encouraging data is emerging on short and medium term graft outcomes in adults, ABOi in children is rare; pre-transplant conditioning in paediatric patients remains challenging and concerns persist about an increased risk of rejection. Encouraged by good results in a large number of adult ABOi transplants, we extended our programme to paediatric recipients, and here report the largest European cohort.

Methods A retrospective analysis of all ABOi paediatric renal transplant recipients in the 2 largest centres in the UK sharing the same tailored desensitisation protocol. Patients with pre-transplant titres 1 in 8 or above received rituximab one month prior to transplant; tacrolimus and mycophenolate mofetil were started one week pre-op. Antibody removal was performed to reduce titres to 1 in 8 or less at surgery. No routine post-op removal was performed.

Results Ten children (age 2–14 years) underwent an ABOi kidney transplant (Figures 1 and 2 and Table 1). Graft and patient survival was 100%. Baseline titres, tailored desensitisation and graft outcomes are shown in table. One patient developed grade IIa rejection after 2 weeks successfully treated with anti-thymocyte globulin;no histological evidence of rejection in other 9 patients. Another patient had a rise in titre of 2 dilutions at week one treated with 2 immunoadsorption sessions. Nine patients had good graft function (eGFR 30–130 mls/min/1.73m2) at last follow up (range 1–36 months); one patient had eGFR 22 ml/min/1.73m2. One patient developed CMV and BK; another EBV and BK.

Abstract G473 Figure 1

Blood group titre levels at baseline, week 1 and 2 and month 1 and 3 post transplant

Abstract G473 Figure 2

Tailored desensitisation strategy for antibody removal

Abstract G473 Table 1

DFPP-double filtration plasmapheresis; R-rituximab; IVIG-intravenous immunoglobulin; IA-immunoadsorption; *deceased patient

Conclusion ABOi transplantation in children appears to have an optimal outcome with good graft survival, low risk of rejection and infectious complications.

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