ABO‐incompatible living kidney transplantation

Abstract

To date, kidney transplantation is the optimal replacement therapy for most patients with end-stage renal disease (ESRD) because of a higher survival rate and decreased cost. 1,2 However, many patients have to undergo dialysis for many years owing to the growing kidney transplantation waiting list and organ scarcity. To overcome the shortage of available organs, various strategies have been established. Apart from increased deceased donor and marginal kidney use, more attention has been focused on expanding the living donor pool, mainly including crossing the HLA/ABO barrier and kidney paired donation (KPD). ABO-incompatible living kidney transplantation (ABO-ILKT) was once believed to be the absolute contraindication to kidney transplantation because of hyperacute humoral rejection and early graft loss. 3 However, with the introduction of antibody removal methods and evolving immunosuppressive protocols, ABO-ILKT currently is conducted widely with graft survival equivalent to that of ABOcompatible living kidney transplantation (ABO-CLKT). 4 Currently, more than a quarter and one third of the living donor kidney transplantation in Germany and Japan, respectively, are ABO-ILKT. 5,6 Instead of overcoming ABO incompatibility, the concept of KPD is to avoid the incompatibility barrier. KPD has been performed in many countries, including the Netherlands, the United States, Canada, Australia, the United Kingdom, Turkey, and India and has the advantages of low immunological risk, cost-effectiveness, and avoidance of desensitization complications, such as infection and bleeding. 5 Nonetheless, these limitations should be considered because of a long waiting period, blood group imbalance, geographical distance, and highly sensitized patients accumulating in KPD registries and

Current Perspectives in ABO-Incompatible Kidney Transplant

“…Moreover, PEX is the less expensive and more widely and rapidly available apheresis technique. 38 , 39 …”

Global Perspective on Kidney Transplantation: China

“…Postoperative maintenance immunosuppressants typically involve the use of calcineurin inhibitors (CNIs) combined with mycophenolic acid and glucocorticoids [7]. Some centers are trying new immunosuppressive programs, such as rituximab [8]. Some experimental methods, such as gut microbiota, are also undergoing preclinical research [9].…”

ABO incompatibility in renal transplantation

“…Removal of circulating ABO antibodies: Various methods have been used for decreasing ABO antibodies titer including plasmapheresis, immunoadsorption, double filtration plasmapheresis, and selective plasma exchange[ 23 ]. While the latter showed less adverse effects due to the preservation of essential plasma components, studies showed that single-use of selective plasma exchange was less efficient than unselective immunoadsorption in removing the circulating ABO antibodies[ 24 ].…”

“…Malignancy: There is no statistically significant difference in developing malignancy between ABO-I and ABOC groups despite aggressive induction therapy[ 23 , 6 , 47 , 49 ].…”