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Therapeutic apheresis in ABO‐incompatible kidney and liver transplantation: A single‐center experience of 50 patients

ABO antigens play an important role in solid organ transplantation. Desensitization for ABO incompatibility offers patients awaiting transplant a larger donor pool. The aim of this study was to assess outcome of desensitization using the institutional preconditioning protocol in ABO‐incompatible solid organ transplants. A retrospective analysis of ABO‐incompatible solid organ transplants between October 2015 and June 2018, at a tertiary healthcare center was performed. The preconditioning regimen consisted of immunosuppression and therapeutic apheresis (TA). Pre‐ and post‐TA titers were performed, until a target titer of 8 or below was achieved, at which transplant was performed. Follow‐up data till 1 year was analyzed. A total of 50 ABO‐incompatible solid organ transplantations, including 14 liver transplants and 36 renal transplants were analyzed. The median baseline anti‐A and anti‐B titers were 192 and 256, respectively. A total of 150 therapeutic plasma exchange (TPE) procedures were performed for renal transplant recipients; 19 TPE and eight immunoadsorption procedures (five preoperative and three intraoperative) were performed for liver transplant recipients. Five (10%) patients experienced minor adverse events. Biopsy revealed antibody‐mediated rejection was observed in three cases in the immediate posttransplant phase and in three (6.67%) cases over 1 year. There was one death due to transplant‐associated thrombotic microangiopathy. Graft survival for renal transplant was 100% and death‐censored graft survival for liver transplant was 100%. Despite difficulties, ABO‐incompatible transplants can be performed without antibody‐mediated rejection with the use of an appropriate protocol.