Haematological Problems and their Solutions in ABO-Incompatible Renal Transplants

We report on the haematological complications that we have encountered in implementing ABO-incompatible kidney transplantation, and the solutions we have used to overcome these. We have performed 5 ABO-incompatible transplants with an immunosuppression protocol involving Rituximab, immunoadsorption, Tacrolimus, Mycophenolate Mofetil, and Prednisolone. Our protocol for blood product transfusion includes the use of high titer negative or washed red cells, high titer negative platelets or platelets in platelet suspension medium, and type AB fresh frozen plasma. Two patients required 2 units of washed red cells each and one required 2 units of platelets in platelet suspension medium at the time of surgery. The other two patients did not require any blood products. One of these, had an episode of acute vascular rejection which was successfully treated. All grafts are currently doing well with a mean serum creatinine concentration of 115µmol/L (1.3mg/dL). The immunoadsorption protocol employed in ABO-incompatible transplantation has a number of effects on red cell, white cell, and platelet counts that could potentially affect the outcome of the transplant. The use of suitably prepared blood products prevents transferring of incompatible antibodies, and allows transplantation to proceed without any increase in risk of graft rejection.