An update on ABO-incompatible kidney transplantation

Zschiedrich, Stefan; Kramer-Zucker, Albrecht; Jänigen, Bernd; Seidl, Maximilian; Emmerich, Florian; Pisarski, Przemyslaw; Huber, Tobias B.

doi:10.1111/tri.12485

Cited by 44 publications

(33 citation statements)

References 109 publications

(125 reference statements)

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“…In agreement with previous reports, C4d staining along peritubular capillary walls was found more often in the ABOi group compared to ABOc group of patients. However, this finding was not accompanied by histological findings of AMR [6,2224] . No other significant differences were found in histological parameters on kidney biopsies between ABOi and ABOc patients.…”

Section: Melexopoulou C Et Al Abo-incompatible Kidney Transplantationmentioning

confidence: 89%

Excellent long term patient and renal allograft survival after ABO-incompatible kidney transplantation: Experience of one center

Melexopoulou

Marinaki

Liapis

et al. 2015

WJT

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AIM:To investigate the long-term results of ABOincompatible (ABOi) kidney transplantation in a single center in Greece. Melexopoulou C et al . ABO-incompatible kidney transplantation or mycophenolate acid was administered. We compared the long term results of our ABOi group to those of a matched group of 30 ABO compatible (ABOc) living kidney recipients with similar baseline characteristics. The ABOc recipients received an immunosuppressive regimen consisting of TAC and mycophenolate acid. All patients in both groups received induction therapy with Basiliximab or Daclizumab, whereas corticosteroids were instituted on the day of surgery. During the followup period, indication biopsies were performed and interpreted by an experienced nephropathologist. The parameters we analyzed included the following: Donor/ recipient age, gender, blood type, human leukocyte antigen mismatches, panel reactive antibodies, primary cause of renal failure, mean time on dialysis, immunosuppressive regimen, patient survival, graft outcome, incidence of rejections, surgical and infectious complications. METHODS: RESULTS:The mean follow-up period was 6 years (range 1 to 9 years). A mean of 5.0 ± 3.0 (range 0-14) pre-transplant immunoadsorptions were required in order to reach the target titer. Patient survival in ABOi group in comparison to ABOc group at 1, 3, 5 and 8 years did not differ significantly (100% vs 100%, 96% vs 100%, 92% vs 100% and 92% vs 100%, P = ns).Additionally, graft survival was similar in the two groups at the same time points (100% vs 100%, 96% vs 96%, 92% vs 96% and 81% vs 92%, P = ns). The mean serum creatinine and the estimated glomerular filtration rate by the modification of diet in renal disease formula at 1, 3, 5 and 8 years did not differ significantly between ABOi and ABOc group. None of the patients in the ABOi group developed acute or chronic antibodymediated rejection evidenced by histological signs. Four patients (13.3%) in the ABOi group and 3 (10%) in the ABOc group experienced acute cellular rejection, which was treated successfully in all cases. Bacterial and viral infections were also similar between the two groups. CONCLUSION:ABOi kidney transplantation is a safe and effective alternative that enables kidney transplantation in countries with unacceptably long deceaseddonor waiting lists. Core tip: These excellent long term results further establish ABO-incompatible (ABOi) kidney transplantation as a safe and effective therapeutic strategy for the management of end-stage renal disease patients. Various immunosuppressants including Everolimus could be potentially selected based on patient's profile. ABOi kidney transplantation could contribute to the enlargement of the living donor pool, particularly in countries with organ shortage.

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Section: Melexopoulou C Et Al Abo-incompatible Kidney Transplantationmentioning

confidence: 89%

Excellent long term patient and renal allograft survival after ABO-incompatible kidney transplantation: Experience of one center

Melexopoulou

Marinaki

Liapis

et al. 2015

WJT

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“…As a result, it has become an acceptable treatment option in Japan, accounting for more than 30% of all living donor kidney transplantation. Excellent outcomes have been achieved, and the rates of graft survival in these patients are presently similar to those in recipients of ABO-compatible grafts [3][4][5][6][7]. Although our previous report demonstrated that this procedure may become a viable treatment option for elderly patients with ESKD [8], there have been few reports on elderly ABO-incompatible kidney transplantation.…”

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confidence: 93%

Favorable Outcomes of Elderly ABO-Incompatible Kidney Transplantation-Pilot Single Center Experience

et al. 2018

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Background: The growth in the end-stage kidney disease (ESKD) population has been predominantly in the older adult population. In Japan, ABO-incompatible kidney transplantation has become an acceptable treatment option. However, few studies have been conducted on elderly ABO-incompatible kidney transplantation. Patients and Methods: Seventeen patients aged 60 years and older who received their grafts from ABO-incompatible living donors at our institution between December 2006 and September 2016 were enrolled in this study, and the outcome of these recipients was evaluated. Results: All 17 patients underwent successful kidney transplantation. Both overall patient and graft survival rates were 100, 100, and 83.3% at posttransplant 1, 3, and 5 years respectively. Six of the 17 patients (35.3%) had an episode of biopsy-proven acute cellular rejection. Two patients who developed steroid- and deoxyspergualin-resistant acute rejection required anti-human thymocyte immunoglobulin. Conclusion: ABO-incompatible kidney transplantation may be an effective radical renal replacement therapy for elderly patients with ESKD, although it could be a high-risk procedure.

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“…Nowadays, graft survival of ABOi KT recipients matches those of ABO-compatible (ABOc) KT recipients (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

“…In cases that have low isohemagglutinin titers, ABOi KT can be performed with a reduced risk of acute AAMR and without the need for rituximab and apheresis (16 Hemagglutination is regarded as the preferable method to quantify isohemagglutinins, and s still commonly used (49). It is based on semi-quantitative measurement of blood-group-specific IgM (direct agglutination) or IgG (indirect detection using antiIgG reagents) (15,50). Alternative techniques used to detect anti-A/B antibodies include flow cytometry and surface plasmon resonance, which is a cell-independent method that enables detection-reagent-independent analysis of antibody-antigen binding using immobilized blood group A or B trisaccharides (6,51,52).…”

Section: Introductionmentioning

confidence: 99%

“…This is followed by administration of intravenous immunoglobulin (IV-Ig), which is considered an immunomodulator by preventing antibodies binding to their particular receptors. It is believed that IV-Ig interacts with Fc receptors on phagocytes and B-cells, and inhibits T-cell differentiation and stimulation (15,56). This protocol is completed with maintenance immunosuppressive drugs that include calcineurin inhibitors (CNI), mycophenolic acid (MPA), and corticosteroids (57).…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcomes after ABO-incompatible kidney transplantation; a single-center French study

Abdulrahman¹,

Naciri²,

Allal³

et al. 2017

J Nephropathol

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Background: ABO-incompatible (ABOi) is as efficient as ABO-compatible (ABOc) kidneytransplantation in the setting of live-donation. Objectives: To evaluate the long-term outcomes (i.e. >6 months) of 44 consecutive ABOi living-donor kidney-transplants (KTx). The results were compared to those from 44 ABOc KTx that were matched with ABOi-patients on age, gender, and date of transplantation. Patients and Methods: With regards to immunosuppression (IS) only ABOi-patients received pre-transplant IS, that included rituximab. Induction therapy relied significantly more frequently on basiliximab in ABOc-than in ABOi-patients 77.2% vs. 38.6% (P = 0.0002). Post-transplant IS relied only on tacrolimus/mycophenolic acid and steroids in ABOipatients, whereas some ABOc-patients were alternatively on cyclosporine (13.6%)/ everolimus (11.3%) and no steroids (7%), respectively (P = 0.05). Results: In ABOi-patients there was no isoagglutinin titer rebound posttransplant. At last follow-up patient and graft survival was similar in the two groups, as well as kidneyallograft function. Acute rejection rates (cellular, humoral, or mixed) were similar across both groups (ABOi: 22.7%; ABOc: 20.4%). With regards to bacterial and viral infections the only significant difference between the two groups was that at month three there were significantly more BKV viruria in ABOi (25%) vs. 6.8% in ABOc (P = 0.03). De novo donor-specific alloantibody were detected in 13.6% ABOi and 4.5% ABOc patients (ns). Readmission rates in our department for less than two days were more frequent for ABOi conversely readmission rates for more than two days was similar across the groups. Conclusions: ABOi-kidney transplantation after desensitization provides in the long-term same results as those observed in live-donor ABOc-kidney transplantation.

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An update on ABO-incompatible kidney transplantation

Cited by 44 publications

References 109 publications

Excellent long term patient and renal allograft survival after ABO-incompatible kidney transplantation: Experience of one center

Excellent long term patient and renal allograft survival after ABO-incompatible kidney transplantation: Experience of one center

Favorable Outcomes of Elderly ABO-Incompatible Kidney Transplantation-Pilot Single Center Experience

Long-term outcomes after ABO-incompatible kidney transplantation; a single-center French study

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