ABO-Incompatible and human leukocyte antigen-incompatible kidney transplant in a highly sensitized patient with hepatitis-B

A 40-year-old female of Indian origin underwent spousal donor ABO-incompatible (ABOi) kidney transplantation. She was diagnosed to have end-stage kidney disease, around 1 year before transplant and it was presumed to be chronic tubulointerstitial nephritis. The female was detected to have acute hepatitis B, 2 months before transplant. She was a highly-sensitized patient with a prior history of blood transfusion and multiparity. Single-antigen bead assay was positive pretransplant. The removal of anti-human leukocyte antigen donor-specific antibodies and anti-B antibodies in our patient was a multi-step process. Timely initiation of antiviral therapy is crucial to reduce viral load and make the patient fit for transplantation. Despite a multitude of risk factors, our patient underwent successful kidney transplantation with a baseline creatinine of 0.6 mg/dL and excellent graft function.