Thursday July 05, 2018 from 09:45 to 11:00
Successful ABO and HLA Incompatible Renal Transplantation in Children in the United Kingdom over the Last Decade
Eun Yee Hew1,2, Nizam Mamode2,3, Nicos Kessaris2,3, Martin Christian4, Jan Dudley5, David Milford6, Yincent Tse7, Nick Webb8, Jelena Stojanovic2,3, Stephen Marks1,2.
1University College London Great Ormond Street Institute of Child Health, London, United Kingdom; 2Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; 3Evelina London Children’s Hospital, London, United Kingdom; 4Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; 5Bristol Royal Hospital for Children, Bristol, United Kingdom; 6Birmingham Children’s Hospital, Birmingham, United Kingdom; 7Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom; 8Royal Manchester Children’s Hospital, Manchester, United Kingdom
Introduction: There is increasing evidence of good short- and medium-term outcomes for ABO incompatible (ABOi) and HLA incompatible (HLAi) with pre-transplant positive crossmatches in paediatric practice. However, there are concerns regarding the higher risks of infective complications and antibody-mediated rejections. The aim of this paper is to show that the short-term outcomes for ABOi and HLAi renal transplantation are comparable to (ABOc/HLAc) compatible renal transplants in children in the UK.
Methods: Data were obtained from the UK Transplant Registry (NHS Blood and Transplant) on all children (aged <18 years) who received a first living paediatric kidney only transplant between 1 January 2006 and 31 December 2016 from 10 paediatric transplant centres. Baseline demographic data were collected of 709 first living paediatric kidney only transplants, of which 23 were ABOi and 4 were HLAi. Estimated glomerular filtration rate (eGFR) was calculated using plasma creatinine at three months post-transplant. Comparisons of graft function following transplantation were made between ABOi, HLAi, and ABOc/HLAc compatible groups.
Results: Pre-emptive transplantation occurred in 35% and 25% of ABOi and HLAi recipients with delayed graft function in 6%, 6% and 0% of ABOc/HLAc, ABOi and HLAi respectively with no cases of primary non-function. Renal allograft survival was 100% in each group although there was one death of ABOi pRTR with a functioning graft. For ABOi transplants (n=16), the median and inter-quartile range (IQR) eGFR was 88 (63 - 150) mls/min/1.73m2. The eGFR in ABOc/HLAc group had a median (IQR) of 101 (74 - 144) mls/min/1.73m2. No statistically significant difference was found between these transplant groups due to the small number of patients.
Discussion: The short term outcomes from this follow-up have shown that ABOi and HLAi renal transplantation are possible for paediatric renal transplant recipients in situations where no compatible donors are available.