ABO-incompatible living-donor kidney transplantation in a developing country: A multicenter experience in Malaysia

Gan, Chye Chung and Jalalonmuhali, Maisarah and Nordin, N. Z. and Wahab, M. Z. Abdul and Yahya, R. and Ng, Kok Peng and Tan, S. Y. and Lim, S. K. (2021) ABO-incompatible living-donor kidney transplantation in a developing country: A multicenter experience in Malaysia. Transplantation Proceedings, 53 (3). pp. 856-864. ISSN 0041-1345, DOI https://doi.org/10.1016/j.transproceed.2020.10.038.

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Malaysia has a low deceased-donor donation rate and has not embarked on a paired kidney exchange program; therefore, ABO-incompatible and HLA-incompatible transplantation remain the main contributor to the sustainability of the national kidney transplantation (KT) program. There were 26 cases of ABO-incompatible KTs performed from 2011 to 2018 in 3 major transplant centers, namely, Hospital Kuala Lumpur, University Malaya Medical Centre, and Prince Court Medical Centre. We collected perioperative and follow-up data through June 2019. The desensitization protocol varies and is center specific: the localized Japanese protocol and Swedish protocol with a target anti-A/B isoagglutinin titer of 16 or 32 on the day of transplant. The induction and tacrolimus-based maintenance protocol was nearly identical. The median follow-up time was 62.3 months (interquartile range, 37.0-79.7). Fifteen subjects had the highest predesensitization anti-A/B titer of >= 32 (57.7%). The acute cellular rejection and antibody-mediated rejection incidence were 12.5% (3 cases) and 8.3% (2 cases), respectively. Patient, graft, and death-censored graft survival rates were 96.2%, 92.3%, and 96.0%, respectively, 1 year post-living-donor KT (LDKT) and 96.2%, 87.2%, and 90.7%, respectively, 5 years post-LDKT. Our experience shows that ABO-incompatible LDKT using a suitable desensitization technique could be a safe and feasible choice for LDKT even with varied desensitization regimens for recipients with relatively high baseline isoagglutinin titers.

Item Type: Article
Uncontrolled Keywords: Donation; Outcomes
Subjects: Q Science > QR Microbiology > QR180 Immunology
R Medicine > RD Surgery
Divisions: Faculty of Medicine > Medicine Department
Depositing User: Ms Zaharah Ramly
Date Deposited: 08 Jul 2022 05:15
Last Modified: 08 Jul 2022 05:15
URI: http://eprints.um.edu.my/id/eprint/33939

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