AUTHOR=Bleasel Jonathan M. , Wan Susan S. , Chadban Steven J. , Ying Tracey , Gracey David M. , Aouad Leyla J. , Chen Qian-Ao , Utsiwegota Mike , Mawson Jane , Wyburn Kate R. 

TITLE=ABO Incompatible Kidney Transplantation Without B-cell Depletion is Associated With Increased Early Acute Rejection: A Single-Center Australian Experience

JOURNAL=Transplant International

VOLUME=Volume 36 - 2023

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.11567

DOI=10.3389/ti.2023.11567

ISSN=1432-2277

ABSTRACT=<p>We performed a single-center retrospective cohort study of 66 consecutive ABO incompatible kidney transplants (ABOiKT) performed without B-cell depleting therapy. Outcomes were compared to an earlier era performed with rituximab (<italic>n</italic> = 18) and a contemporaneous cohort of ABO compatible live donor transplants (ABOcKT). Acute rejection within 3 months of transplant was significantly more common after rituximab-free ABOiKT compared to ABOiKT with rituximab (OR 8.8, <italic>p</italic> = 0.04) and ABOcKT (OR 2.9, <italic>p</italic> = 0.005) in adjusted analyses. Six recipients of rituximab-free ABOiKT experienced refractory antibody mediated rejection requiring splenectomy, and a further two incurred early graft loss with no such episodes amongst ABOiKT with rituximab or ABOcKT cohorts. Patient and graft survival were similar between groups over a median follow-up of 3.1 years. This observational evidence lends strong support to the continued inclusion of rituximab in desensitization protocols for ABOiKT.</p>