12 patients had CMV viraemia and 5 patients had BK viraemia during this period. Annual incidence of CMV viraemia varied from 4.8–12.5% while
BK viraemia ranged from 2.9–8.3%(both peaking in 2013). The majority of presentations occurred within the first year post-transplant. Most patients with CMV viraemia had donor positive/recipient negative (D+/R−) transplants. The average immunosuppression dosing within the first year post-transplant in CMV-infected patients was tacrolimus 3 mg bd, MMF 750 mg bd, prednisolone 7 mg od with similar doses in BK-infected patients. Conclusions: Our results (including the peak incidences in 2013) are in keeping with the current worldwide incidence and prevalence of CMV and BK infection in renal transplant patients. Immunosuppression
dosing within the first selleck chemicals llc year in infected patients was within acceptable limits according to our transplant hospital’s guidelines. Patients with CMV infection had increased risk factors including transplant rejection and incomplete prophylaxis periods. A protocol to standardise the tapering of immunosuppression as well as screening for CMV and BK viraemia would highlight at-risk patients and potentially lower incidence rates of CMV and BK viraemia further. 269 RISING ANTI BLOOD GROUP ANTIBODY TITRES A WARNING SIGN OF RENAL ALLOGRAFT INFARCTION IN THE CONTEXT OF ABO INCOMPATIBLE RENAL TRANSPLANTATION R MASTERSON, M LEE, P HUGHES Department of Nephrology, Royal Melbourne Hospital, Australia The target of anti blood group antibodies are carbohydrate moieties added to the glycoproteins defining the O antigens on RBC. ABO antigens also exist GSK-3 beta pathway on other cells including the endothelial and epithelial cells of the kidney. Hyperacute rejection is induced by the binding of anti-A /B to antigens expressed on the endothelial cells of the ABOi graft. In most cases an acute
rise in ABO antibodies heralds underlying AbMR however we describe 2 cases where a rise in ABO Abs was caused by graft infarction with no evidence of AbMR. Case 1: A to B LRTx. Peak anti A titre (ortho) pre transplant 1:16. Plasma exchange x 2 pre-op with titre being 1 on day of surgery. Creatinine fell to 100 μmol/L and anti A titre remained 1 on Day 5. Day 7 creatinine increased and peaked at 500 μmol/L until on day 10. Anti A titre rose exponentially (1:128) despite daily plasma exchange. Biopsy c/w haemorrhagic infarction but no AbMR. A transplant nephrectomy was performed. Case 2: B to O LURTx. Peak anti B titre 1:32. Plasma exchange x 3 pre-op with anti B titre being 1 on day of surgery. Creatinine fell to 99 μmol/L by Day 3 with anti B titre being 1. On Day 4 there was a sharp rise in creatinine to 350 μmol/L with increase in anti B titre to 1 : 256 despite plasma exchange. A biopsy was consistent with major vascular compromise but no AbMR. Anti B titre peaked at 1:512 and graft nephrectomy was performed, confirming an infracted kidney and renal vein thrombosis.