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J Nephropathol. 2016;5(1): 19-27.
doi: 10.15171/jnp.2016.04
PMID: 27047806
PMCID: PMC4790183
  Abstract View: 3695
  PDF Download: 2001

Original Article

Early post-transplant complications following ABO-incompatible kidney transplantation

Hamza Naciri Bennani 1, Zhyiar Abdulrahman 1, Asma Allal 1, Federico Sallusto 2, Antoine Delarche 1, Xavier Game 1,2, Laure Esposito 1, Nicolas Doumerc 2, Bénédicte Debiol 3, Nassim Kamar 1,4,5, Lionel Rostaing 1,4,5*

1 Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
2 Department of Urology, Andrology, and Transplantation, CHU Rangueil, Toulouse, France
3 Etablissement Français du Sang de Midi-Pyrénées, CHU Purpan, Toulouse, France
4 INSERM U563, IFR–BMT, CHU Purpan, Toulouse, France
5 Université Paul Sabatier, Toulouse, France
*Corresponding Author: *Corresponding author: Prof. Lionel Rostaing, Department of Nephrology and Organ Transplantation, CHU Rangueil, TSA 50032 Toulouse, France. , Email: rostaing.l@chu-toulouse.fr

Abstract

Background: Living-kidney transplantation is increasing because of the scarcity of kidneys from deceased donors and the increasing numbers of patients on waiting lists for a kidney transplant. Living-kidney transplantation is now associated with increased long-term patient- and allograft-survival rates.

Objectives: The purpose of this retrospective study was to identify, in a cohort of 44 ABO-incompatible (ABOi) live-kidney transplant patients, the main complications that occurred within 6 months post-transplantation, and to compare these findings with those from 44 matched ABO-compatible (ABOc) live-kidney transplant patients who were also from our center.

Patients and Methods: This single-center retrospective study assessed post-transplantation complications in 44 ABO-i versus 44 matched ABO-c patients. All patients were comparable at baseline except that ABO-i patients had greater immunological risks.

Results: During the 6-month post-transplant period, more ABO-i patients presented with postoperative bleeds, thus requiring significantly more blood transfusions. Bleeds were associated with significantly lower values of fibrinogen, platelets, prothrombin time, and hemoglobin levels. Surgical complications, patient- and graft-survival rates, and kidney-function statuses were similar between both groups at 6 months post-transplantation.

Conclusions: We conclude that impairment of hemostatic factors at pre-transplant explained the increased risk of a post-transplant bleed in ABO-i patients.


Implication for health policy/practice/research/medical education:

ABO-incompatible (ABOi) live-kidney transplantation allows increasing the total number of kidney transplantation. It is associated in the long-term with similar results to those obtained with ABO-compatible (ABOc) live-kidney transplantation provided pre-transplant desensitization that includes immunosuppressive drugs and apheresis in order to remove isoagglutinins that might result in acute humoral rejection. However, pre-transplant apheresis might result in coagulation disorders which may lead to peri-transplant bleedings.

Please cite this paper as: Naciri Bennani H, Abdulrahman Z, Allal A, Sallusto F, Delarche A, Game X, et al. Early post-transplant complications following ABO-incompatible kidney transplantation. J Nephropathol. 2016;5(1):19-27. DOI: 10.15171/ jnp.2016.04

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