A Successful Pediatric ABO Incompatible Transplant Using Reusable Vitrosorb Column.

BACKGROUND: End-stage renal disease (ESRD) is a critical global health concern, with kidney transplantation being the preferred treatment for children with stage 5 chronic kidney disease. However, ABO-incompatibility (ABOi) poses a major barrier to successful transplantation. While advances in antibody removal techniques, including immunoadsorption (IA), have enabled ABOi kidney transplantation, cost remains a significant challenge, especially in low-resource settings. Most available data focus on adults, with limited pediatric reports, particularly using reusable IA columns.

CASE PRESENTATION: We report the case of a 7-year-old girl who underwent ABOi kidney transplantation from her mother, despite an exceptionally high pretransplant anti-B IgG antibody titer of 1:1 024. She received a single dose of Rituximab (200 mg) 14 days pretransplant, followed by two IA sessions using a reusable Vitrosorb IA column. The first session reduced titers to 1:16, but a rebound increase to 1:128 necessitated a second session, bringing titers down to 1:8. A final plasmapheresis session stabilized titers before transplantation. The surgery was uneventful, and post-transplant antibody levels remained controlled. The patient demonstrated good graft function and was discharged in stable condition.

DISCUSSION & CONCLUSION: This is the highest reported pretransplant titer (1:1 024) in a pediatric ABOi kidney transplant case. The use of a reusable Vitrosorb IA column proved both effective and cost-efficient, making it a viable option in resource-limited settings. Our findings suggest that IA reuse is safe, reduces financial burden, and warrants further investigation for broader clinical application.