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. 2023 Feb;38(2):529-535.
doi: 10.1007/s00467-022-05583-5. Epub 2022 Jun 13.

Successful ABO and HLA incompatible kidney transplantation in children in the UK

Eun Yee Hew  1 , Nicos Kessaris  2   3   4 , Jelena Stojanovic  2 , Helen Jones  4 , Martin Christian  5 , Anusha Edwards  6 , David V Milford  7 , Milos Ognjanovic  8 , Mohan Shenoy  9 , Richard J Baker  10 , Stephen D Marks  11   12
Affiliations

Successful ABO and HLA incompatible kidney transplantation in children in the UK

Eun Yee Hew et al. Pediatr Nephrol. 2023 Feb.

Abstract

Background: There is increasing evidence of good short-term and medium-term outcomes of ABO incompatible (ABOi) and HLA incompatible (HLAi) kidney transplantation with pre-transplant positive crossmatches in paediatric practice. However, there remain concerns regarding the higher risks of infective complications and antibody-mediated rejections. The aim of our study is to show longer-term follow-up on all ABOi and HLAi paediatric kidney transplant recipients (pKTR) in the UK.

Methods: Questionnaires specifying kidney transplant type, desensitisation requirement and kidney allograft function were sent to 13 paediatric nephrology centres that performed kidney transplantation in children and young people under 18 years of age who received an ABOi and/or HLAi transplant between 1 January 2006 and 31 December 2016. Patient and kidney allograft survival were compared between ABOi, HLAi and ABO/HLA compatible (ABOc/HLAc) groups.

Results: Among 711 living donor kidney transplants performed in the UK, 23 were ABOi and 6 were HLAi. Patient survival was 87%, 100% and 96% in ABOi, HLAi and ABOc/HLAc groups, respectively, at median follow-up of 6.8 (3.6-14.0) years post-transplant. Death-censored kidney allograft survival was 100% in all 3 groups at last follow-up. There were no cases of primary non-function in ABOi or HLAi groups, but 2% in the ABOc/HLAc group. There was one reported case of Epstein-Barr viral-induced post-transplant lymphoproliferative disorder.

Conclusion: Longer term follow-up has shown that ABOi and HLAi kidney transplantation are feasible for pKTR where no compatible donors are available, and that minimising desensitisation should be achieved where possible. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: ABO-incompatible; Desensitisation; HLA-incompatible; Kidney transplantation; Paediatric.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curve comparing patient survival between ABOi, HLAi and ABOc/HLAc groups
See this image and copyright information in PMC

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