Background: Presence of hematologic disorder such as severe aplastic anemia (SAA) can be a significant obstacle for successful kidney transplantation (KT) in end-stage kidney disease (ESKD). In this study, we report seven cases of KT in ESKD patients with severe aplastic anemia.
Methods: We reviewed seven KT recipients (KTRs) who had either SAA or received hematopoietic stem cell transplantation (HSCT) for SAA. We analyzed baseline characteristics of KTRs and their allograft outcomes, focusing on survival rates, rejection incidence, and both infectious and surgical complications.
Results: Out of the seven patients, four underwent KT while having ESKD and SAA. Among these four KTRs, two received HSCT within 2 months of their KT. Another two did not received HSCT because complete blood count profiles were improvement after KT. Before KT, average absolute neutrophil count, hemoglobin, and platelet count were 4.1±2.2 (10³/μL), 8.9±2.3 (g/dL), and 36.0±22.1 (10³/μL), respectively, and baseline bone marrow cellularity was less than 15% in all patients. The other three out of total seven patients received HSCT before undergoing KT, and their blood count profiles were normal. The average time between HSCT and KT was 12.5±10.1 years. All KTRs did not experience acute rejection within 1-year after KT. Surgical complications including major bleeding did not occur after KT. Two out of seven KTRs suffered from upper urinary tract infection including graft abscess and one out of seven KTRs had herpes zoster, who needed hospitalization. Only one out of seven KTRs experienced graft failure, 69 months after KT, and no patient death developed. Four out of five KTRs who received HSCT and KT from same donors successfully discontinued immunosuppressant.
Conclusions: In conclusion, for the treatment of combined state of ESKD and SAA, KT followed by HSCT can be done safely without significant complications.