A Case Report: First Ever ABO Incompatible Kidney Transplantation in Bangladesh: The Start of a New Era

Abstract

Although ABO incompatible kidney transplantations are increasingly being practised worldwide, in Bangladesh it was never attempted. Here we report the first ever ABO incompatible kidney transplantation case performed in Bangladesh. The patient was a 23-year-old male with end-stage kidney disease secondary to chronic glomerulonephritis on haemodialysis. The only kidney donor available was his mother who had a different blood-group (patient O positive; mother A positive). His baseline anti-A IgG titre was 1:128. We used a modified desensitization protocol with low-dose Rituximab, triple immunosuppression (Tacrolimus, Mycophenolate Sodium and Prednisolone) and 3 sessions of plasmapheresis followed by IVIG. His Anti-A IgG titre was brought down to 1: 8 before transplantation. He also received basiliximab as induction therapy. He successfully underwent renal transplantation across the ABO barrier. After transplantation his IgG titre was monitored which was remained 1:4. At 1, 3 and 6 months of post transplant, serum creatinine level was 207 µmol/L, 182 µmol/L and 183 µmol/L, respectively. This was the first case of ABO-incompatible kidney transplantation in Bangladesh. This case gives us the confidence that more ABO-incompatible kidney transplantations can be performed in a resource limited setting and high infection risk countries like ours following a more cautious approach. This will substantially increase the living kidney donor pool; hence reduce the economic and health impact of continuing long term dialysis therapy in Bangladesh. Keywords: ABO incompatible kidney transplantation, Anti-A IgG titre, Desensitization, Plasmapheresis, End Stage Kidney Disease