To investigate the clinical efficacy and safety of ABO incompatible donation after cardiac death (DCD) donor kidney transplantation.

Retrospective analysis of clinical data of 8 patients with ABO incompatible DCD donor kidney transplantation performed from December 2016 to June 2018 in the department of transplantation of Guilin NO.924 Hospital of People′ Liberation Army of China. Among them, 6 were male and 2 were female, aged 26-54, 4 were positive for panel reactive antibodies (PRA) and 2 were for secondary renal transplantation. The Rh (D) blood type of donors and recipients were all negative. The individualized preconditioning protocol was established according to the initial blood group antibody titer and the preoperative PRA antibody level. Postoperative routine monitoring of blood concentration of immunosuppressive agents, urine volume, renal function, coagulation status and blood group antibody level, and the change of donor specific antibody level were observed in PRA positive recipients.

Blood group antibody titers were all ≤1∶16 on the day of renal transplantation in 8 recipients after individualized preconditioning. There was no rebound of blood group antibody in 7 patients within 2 weeks after transplantation. Eight recipients had been followed up for an average of 6 to 18 months up to June 2018. Case 1 developed humoral rejection at the second week after transplantation and recovered after immunosorbent assay with protein A and high dose immunoglobulin shock therapy. Case 2 developed bladder bleeding 2 h after transplantation, hemostasis was got after continuous bladder washing and the function of transplant kidney returned to normal. Case 3 was complicated with severe pulmonary fungal infection at the 5th month after transplantation and died of respiratory failure after failure of antifungal treatment. Case 6 was complicated with delayed graft function and recovered after hemodialysis. Case 7 showed less urine volume, right lower extremity deep vein thrombosis (graft side), inferior vena cava mesh implantation and thrombolytic anticoagulant therapy were ineffective and hemodialysis treatment was recovered. Case 8 complicated with drug-induced diabetes 2 months after operation. The renal graft function of the remaining recipients maintained well.

ABO incompatible DCD donor kidney transplantation was safe and effective with individualized preconditioning according to the initial blood group antibody titer and PRA level of the recipient.