Abstract for presentation at Renal Society of Australasia Annual Scientific Conference

Incompatible Kidney Transplantation - Transplanting in the Presence of ABO Blood Group Incompatibility and Donor Specific anti-HLA antibodies

The increasing success of renal transplantation (85% to 90% five year survival) has made it the treatment of choice for patients with end stage kidney disease (ESKD). Currently approximately 1600 Australians are awaiting renal transplantation, and as a result of the donor shortage, one patient dies each week awaiting a kidney transplant. A response to this crisis has been a steady increase in live donor renal transplantation. Unfortunately, over 30% of patients with a potential live donor have a blood group incompatibility or positive cross-match with their intended donor, both of which predict a high risk of early severe rejection (antibody mediated rejection or AbMR) and rapid graft loss, thus precluding transplantation.

Advances in tissue typing now permit the identification and measurement of anti-HLA antibodies responsible causing a positive cross match. This knowledge coupled with other advances in transplantation have enabled the treatment and prevention of AbMR using plasma exchange and intravenous immunoglobulin, thus making it possible to safely perform cross-match positive or ABO incompatible kidney transplantation in selected cases. The increase in live donor renal transplantation that should occur will reduce transplant waiting times, improve survival for patients with ESKD and provide economic benefits to the community at large.

This talk will focus on the background and history of AbMR, incompatible kidney transplantation and the diagnostic and therapeutic tools that have made these advances possible (including the Glycorex immunoabsorbent blood group eluting columns) givng transplant survival rates equivalent to conventional transplantation