LAUSR

Forty-two patients were evaluated for donor specific anti HLA sensi tion before they recivied ABO incompatible kidney transplantation. E recipient was evaluated by complement dependent cytotoxicity (C crossmatch, flow crossmatch, single antigen bead assay (SAB) lysate based solid phase crossmatch Desensitaztion. The desensitization protocol for ABO incompatibile transplant at centre includes infusion of 500 mg of Rituximab which is administe 10 to 12 days prior to KT. 2 to 10 sessions of plasmapheresis depen on titer performed over 2 to 14 days before surgery until a recipie isoagglutinin titer decreased to a level below 1:8. Postoperative Plas pheresis was performed only when the antiA,B isoagglutinin titer above a level of 1:8 within first twoweeks of transplant or patient has g dysfunctionwith graft biopsy is suggestive of ABMR. All theABO-i KT tients received induction therapy with either Basiliximab (an anti-C monoclonal antibody) on the day of kidney transplant (KT). Plasmap resis with IVIG infusions initiated from Day −10. During plasmaphere plasma is replacedwith FFPand 5%Albumin. Immunosuppressants crolimus and MMF) were started 10 days prior to surgery. During transplant surgery 500 mg of iv methylprednisolone is given. Titre anti-A and/or Anti-B are monitored on daily basis with target levels ing < 1:8 by serial tube dilutionmethod on the day of transplant. Induc with Basiliximab (on day 0 and 4) is given in most patients. In high patients, rabbit ATG was given in a total dose of 3–4.5 mg/kg on D and then alternate days post-transplant. One patient in the ABOi tr plant cohort expired within 2 days of transplantation due to refrac septic shock, in the remaining 33, patient survival was 97% and graft vival was 95% at one year follow up period. Antibody mediated rejection (ABMR) was seen in four (9.5%) ou 42 patients. In non sensitized group-A, ABMR was 2.5% and sensit group ABMR was seen in 7.1% with DSA positivity. Graft loss w one month post-transplant was seen in 2 patients due to ABMR with itive DSA only in the sensitized group –B (p value is 0.06). Both these tients had flow CM negative but had SAB DSA and Lysate CM pos with total MFI strength above 5000. Anti HLA DSA positivity with ABO compatibility is associatedwith poor graft survival if MFI ismore than 5