First ABO ‐Incompatible Pediatric Kidney Transplant in South Africa—A Case Report

Background Blood group incompatibility previously represented an obstacle to living related donor (LRD) options; desensitization modalities have expanded LRD options. ABO‐incompatible kidney transplants have been successful in adults and pediatric liver transplants, but to date not yet in pediatric kidney transplants in South Africa. Case Report Patient X is a 5 year old male with end‐stage kidney failure due to Posterior Urethral Valves, requiring peritoneal dialysis pre‐transplant. His sister was the only suitable LRD. The recipient was blood group A+; donor was blood group B+; HLA match was 5/10, nil HLA donor specific antibodies and negative CDC and Flow crossmatches. The recipients' anti‐B titer pre‐transplant was a maximum of 1:8. A pre‐emptive desensitization dose of Rituximab (375 mg/m 2 ) was administered 4 weeks before transplant. The anti‐B titer decreased to 1:2 following the Rituximab (CD19% of 0%). Post‐transplant, the Anti‐B titers were monitored for the first 10 days, with a maximum titer of 1:8 (immunoadsorbtion therapy available if > 1:16, or if associated graft dysfunction). Immunosuppressant protocol consisted of Basiliximab, Tacrolimus, Azathioprine, and Prednisone. Post‐transplant, the creatinine improved to 60–70 μmol/L at Week 1. 7 weeks post‐transplant, serum creatinine increased > 10% with an antibody titer of 1:2. Kidney biopsy showed CNI‐related toxicity; renal function improved with reduction in Tacrolimus doses. Kidney function remains stable 1‐year post‐transplant with nil episodes of rejection. Conclusion This is the first ABO‐incompatible kidney transplant in a pediatric patient in South Africa and represents an important step in expanding the pool of potential living related donors.