Successful Third Kidney Transplant After Desensitization for Combined Human Leucocyte Antigen (HLA) and ABO Incompatibility: A Case Report and Review of Literature

ABO-incompatible repeat kidney transplantation: Coping with the 'twin immunological barrier'

A repeat renal transplantation is believed to confer the best survival advantage for allograft failure. The scarcity of matching donors at one end, coupled with the expanding pool of ABO-incompatible (ABOi) donors at the other end, lead us to consider the option of ABOi kidney re-transplantation. However, ABOi kidney re-transplantation is associated with heightened immunological risk due to the presence of two substantial immunological barriers. Concern, queries, and uncertainty exist over the course and outcome of this option. We prospectively studied five patients who underwent live-related ABOi re-transplantation after a failed previous transplant. Four patients (mean age 40.8 ± 6.6 years, 4 males) underwent a second renal transplant, whereas one patient had a third renal transplant. All patients received desensitization with rituximab, plasmapheresis, and intravenous immunoglobulin as per routine protocol. One patient required immunoadsorption to achieve the desired Anti-ABO titer. All five patients had good graft survival. One of them developed combined antibody and cell-mediated rejection and another antibody-mediated rejection. Live-related ABOi kidney re-transplantation could be a viable option for patients with a previously failed graft.

Efficient Kidney Exchange with Dichotomous Preferences

This paper studies a general kidney exchange model with compatible patient-donor pairs, incompatible patient-donor pairs, single donors, and patients on the waiting list. We derive an explicit formula of the maximal number of feasible kidney transplants under several sizes of cycles and chains of exchange, analyze the effect of different ways of exchange on efficiency, and provide substantial simulation results based on the USA data. Our results further show that kidney exchange can be decentralized for relatively large populations, and that allowing compatible pairs and single donors to exchange with incompatible pairs can significantly increase the number of feasible kidney transplants. A more general model of two-category type-compatible exchanges is also established.