Outcome of desensitization in human leukocyte antigen and ABO incompatible living donor kidney transplantation: Single center experience of first 200 incompatible transplants

J Clin Apher. 2021 Jun;36(3):299-312. doi: 10.1002/jca.21860. Epub 2020 Dec 14.


Background and aims: Although desensitization is well established, concerns about graft outcome, patient survival and rejection still exist. The present study aims at comparing outcomes of renal transplant recipients across simultaneous ABO and human leukocyte antigen (HLA) incompatibility barriers to those with ABO or HLA incompatibility alone.

Materials and methods: This was a retrospective study conducted from October 2015 to December 2018. All patients with a clinical diagnosis of chronic kidney disease, who were prospective HLA incompatible (HLAi) and/or ABO incompatible (ABOi) renal transplant recipients were included. A total of 400 cases including 36 ABOi transplants, 154 HLAi transplants, 10 simultaneously ABO and HLA incompatible transplants, and 200 ABO (ABOc) and HLA (HLAc) compatible kidney transplants from living donors were included.

Results: There were significantly more number of blood transfusions, previous transplants and pregnancies in HLAi transplant recipients relative to the ABOi or the control group. Mean number of therapeutic plasma exchange procedures per patient and mean plasma volume processed per procedure were slightly higher in the ABOi + HLAi category. The incidence of graft dysfunction due to suspected antibody-mediated rejection during first year was highest in the ABOi + HLAi group, followed by ABOc + HLAi and ABOi + HLAc, lowest in the ABOc + HLAc category. Mean time to first episode of graft dysfunction was significantly shorter with incompatible transplants. There were no kidney transplant recipient deaths in the study.

Conclusion: Patient outcome and graft outcomes observed with incompatible transplants were not worse than those observed with compatible transplants.

Keywords: ABO incompatible; desensitization; donor specific anti-HLA antibodies; incompatible kidney transplant; preconditioning; therapeutic plasma exchange.

MeSH terms

  • ABO Blood-Group System / immunology*
  • Adolescent
  • Adult
  • Aged
  • Blood Group Incompatibility*
  • Female
  • Graft Rejection / etiology
  • Graft Survival
  • HLA Antigens / immunology*
  • Humans
  • Kidney Transplantation* / mortality
  • Living Donors*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Young Adult


  • ABO Blood-Group System
  • HLA Antigens