What is the comparison of coagulation profiles between ABO (Agricultural Blood Type Organization) compatible and ABO incompatible kidney transplant recipients?

From the Guidelines

The coagulation profile of ABO incompatible kidney transplant recipients is significantly more hypercoagulable compared to ABO compatible recipients, with a higher risk of thrombotic complications, particularly in the early post-transplant period. This is due to the desensitization protocols used in ABO incompatible transplantation, including plasmapheresis, immunoadsorption, and rituximab, which can affect coagulation parameters 1. The coagulation disturbances in ABO incompatible recipients are characterized by elevated levels of von Willebrand factor, factor VIII, and thrombin generation, along with decreased levels of natural anticoagulants like protein C and antithrombin.

Some key points to consider in the coagulation profiles of these patients include:

• The presence of antiphospholipid antibodies, which have been associated with thrombocytopenia, in vitro coagulation abnormalities, thrombotic events, and fetal abortion 1
• The potential role of homocysteine in graft thrombosis, with elevated plasma homocysteine levels potentially increasing the risk of venous thrombosis 1
• The importance of screening high-risk patients for coagulation abnormalities and prophylactically treating those who have both a prior history of thrombosis and demonstrable coagulation abnormalities 1

The hypercoagulable state in ABO incompatible recipients contributes to a higher incidence of thrombotic events, including renal artery or vein thrombosis, which can compromise graft function. Therefore, understanding these differences is crucial for appropriate prophylactic anticoagulation strategies in ABO incompatible transplant recipients to improve graft survival and reduce thrombotic complications. Clinically, this translates to a need for close monitoring and management of coagulation parameters in ABO incompatible recipients, particularly in the early post-transplant period.

From the Research

Coagulation Profile Comparison

The comparison of coagulation profiles between ABO compatible and ABO incompatible kidney transplant recipients is a crucial aspect of transplantation medicine.

• ABO-incompatible kidney transplantation has been made possible through desensitization protocols that combine plasmapheresis, immunosuppression, and other treatments to reduce anti-A/B antibodies 2, 3.
• Studies have shown that ABO-incompatible kidney transplantation can achieve comparable patient and graft survival rates to ABO-compatible transplantation, with some protocols demonstrating reduced risks of coagulopathy and transfusion reactions 2, 3.
• The use of selective immunoadsorption has been shown to be safer and more effective than plasmapheresis in eliminating anti-A/B antibodies, with reduced risks of plasma and coagulation abnormalities 3.
• However, the impact of HLA-identity on the results of ABO-incompatible living donor kidney transplantation has been investigated, with studies suggesting that HLA-identical donors may have better long-term graft survival rates than HLA-nonidentical donors 4.

Coagulation Abnormalities

Coagulation abnormalities are a potential risk in ABO-incompatible kidney transplantation, particularly with the use of plasmapheresis.

• Plasmapheresis can lead to coagulopathy and transfusion reactions, which can be detrimental to patient outcomes 2, 3.
• Selective immunoadsorption has been shown to reduce the risk of coagulation abnormalities by eliminating anti-A/B antibodies without affecting plasma and coagulation factors 3.
• The use of antigen-specific immunoadsorption has also been shown to be effective in treating acute antibody-mediated rejection caused by ABO antibodies, with efficient clearance of deposited IgG from the kidney allograft and re-establishment of normal kidney function 5.

Treatment Outcomes

The treatment outcomes for ABO-incompatible kidney transplantation have been shown to be excellent, with high patient and graft survival rates.

• Pretransplantation immunosuppression with tacrolimus, mycophenolate mofetil, and steroid has been shown to reduce acute humoral/vascular rejection without serious complications 6.
• The use of rituximab, intravenous immunoglobulin, and basiliximab combined with tacrolimus, mycophenolate mofetil, and prednisolone has also been shown to be effective in treating acute antibody-mediated rejection caused by ABO antibodies 5.