WCN25-4489 ABO & HLA INCOMPATIBLE KIDNEY TRANSPLANT: A SINGLE-CENTER STUDY FROM INDIA

Case 1-A 58 years old male, who underwent 2nd renal transplant on 25.04.2024 with donor being brother.It was ABO compatible transplant with HLA match of 3/6.However,he had donor specific antibodies and he underwent desensitisation with one session of PLEX and 10gm of IvIg.Induction was given with ATG and he was discharged on triple drug immunosuppression with serum creatinine of 0.78 mg/dl.Ten days post transplant the patient presented with blackish discoloration of right foream after trivial trauma (Fig. 1)which on investigating was suggestive of mucormycosis.This eventually lead on to right shoulder disarticulation.Case 2-A 50-year-old male patient is a case of renal allograft recipient (2015) on triple drug immunosuppression (Tacrolimus, Mycophenolate mofetil and Prednisolone), donor wife (O positive to B positive), diabetes mellitus, hypertension, had complaints of pain in left foot for 15 days along with erythematous papular lesion on sole of left foot, for which he was started on oral Clindamycin.Skin lesion gradually increased in size and had purulent discharge as well.He underwent incision and drainage at a nearby clinic and was continued on oral Clindamycin.His complaints of pain and pus discharge persisted for which he presented to our center in March 2023.Debridement was done and the tissue culture was suggestive of Cryptococcus neoformans (Fig. 2).Case 3-61 year male, underwent renal transplant surgery on 09.11.2022, donor being wife and it was ABO incompatible transplant.He is a known case of diabetes mellitus, coronary artery disease and is hepatitis c positive.He presented to our centre in April 2024 with complaints of non healing lesion over forehead for 25 days and low grade fever for 7 days.Skin biopsy was done which founded round fungal yeast forms suggestive of Histoplasma (Fig 3).All the above mentioned cases with treated with intravenous liposomal amphotericin b and surgical intervention.