Page 206 - Hospital Authority Convention 2018

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2018

F5.6 Healthcare Advances, Research and Innovations 09:00 Room 421

The First ABO-Incompatible Kidney Transplantation in Hong Kong: Queen Mary Hospital Experience
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Ma MKM , Hwang GYY , Leung R , Ma WK , Tsu HL , Chan G , Lam C , Choy BY , Lie AKW , Kwok JSY , Chan TM 1
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Department of Medicine, Department of Pathology, Department of Surgery, Queen Mary Hospital, Hong Kong
Introduction
Organ donation rate is low in Hong Kong. Over 2,000 patients with end-stage kidney failure (ESKD) are waiting for kidney
transplantation. There is a pressing need to develop novel means to increase transplant rate, as long-term dialysis is
associated with inferior survival outcome and quality of life than transplantation. ABO-incompatible kidney transplantation
(ABO-i KTx) is an established treatment option worldwide, and the patient and graft outcomes are comparable to conventional
ABO-compatible KTx. With close collaboration between clinicians, laboratory and nursing staff from nephrology team,
clinical haematology team, haemato-pathology and histopathology teams, urology team, Transplantation and Immunogenetic
Laboratory, we successfully performed the first ABO-i KTx in Hong Kong in April 2017.
Objectives
(1) To increase kidney transplantation rate and improve outcomes of ESKD patient; and (2) to reduce healthcare cost incurred
from long-term dialysis and its associated morbidity.
Methodology
A 39-year-old Chinese lady with blood group O RhD+ and ESKD due to unknown primary aetiology received a kidney from
her younger sister whose blood group was B RhD+. Investigations prior to the transplant operation showed one-haplotype
match with negative HLA crossmatch, and an IgG anti-B titre of 1:256 in the potential kidney recipient. The patient then
underwent desensitisation which included four sessions of plasmapheresis and rituximab. After the desensitisation protocol
the anti-B titre decreased to 1:8. Triple immunosuppression comprising prednisolone, tacrolimus and mycophenolate mofetil
was commenced one week before transplantation. The patient also received Basiliximab on Day 0 and Day 4.
Results
The clinical course after transplantation was uneventful. She had immediate graft function which remained stable thereafter,
with serum creatinine at approximately 100 µmol/L. The titre of anti-B antibody increased during post-operative monitoring
and she had one session of plasmapheresis. Protocol allograft biopsy at three weeks post-transplant showed minimal C4d
staining and no rejection. The patient is now more than eight months after transplantation. Our experience with the first ABO-
incompatible kidney transplantation in Hong Kong shows that, as has been demonstrated in other countries, this is a feasible
approach to increase the rate of kidney transplantation and improve patient outcomes.

Tuesday, 8 May 2018

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