Clinical Outcome of ABO-Incompatible Living Unrelated Donor Kidney Transplantation

Uchida, Junji; Machida, Yuichi; Iwai, Tomoaki; Kuwabara, N.; Iguchi, Taro; Naganuma, Takeshi; Kumada, Norihiko; Kawashima, Hidenori; Nakatani, Tatsuya

doi:10.1159/000324103

Cited by 15 publications

(18 citation statements)

References 20 publications

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“…The rate of ABO-incompatibility may be high among kidney transplants from spousal donors, but it has been performed since the late 1980s in Japan due to the severe shortage of deceased donors. Previous reports have shown our superb outcomes of ABO-incompatible kidney transplants, including high-titer cases performed at our institution [8,9,10,12]. However, the outcomes of ABO-incompatible kidney transplantation in elderly patients older than 60 years have not yet been well studied.…”

Section: Discussionmentioning

confidence: 86%

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Clinical Outcome of Elderly Kidney Transplant Recipients from Spousal Donors

et al. 2015

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Introduction: Patients aged 60 years and older stand for the fastest growing group of patients with end-stage renal disease worldwide, and the need for kidney transplants among this population is rising. In Japan, living donor kidney transplantation is mainly performed to deal with the severe shortage of deceased donors, and the number of spousal transplants is currently increasing. Patients and Methods: A total of 164 patients with ESRD underwent living donor kidney transplantation at our institution, of whom 21 patients aged 60 years and older had spousal kidney transplantation. ABO-incompatible kidney transplantation was performed in 5 of the 21 cases. We analyzed these recipients. Results: Patient and graft survival rates were 100%. The incidence of acute rejection was 23.8%. Eight patients experienced cytomegalovirus viremia, two patients experienced Pneumocystis jiroveci infection, and one experienced bacterial pneumonia. Two patients developed cancers and underwent curative operation after transplantation. Conclusions: Elderly kidney transplantation from spousal donors is associated with age-related immune dysfunction, which may develop infections and malignancies and could be immunologically high risk due to the high rate of ABO-incompatibility and poor histocompatibility. An effort to minimize the adverse effect of immunosuppression and to reduce the risk of acute rejection may be needed for an excellent long-term outcome.

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Section: Discussionmentioning

confidence: 86%

“…Briefly, this standard desensitization protocol consisted of 2 doses of rituximab 150 mg/m 2 at 2 weeks before and on the day of transplantation, and pretransplant immunosuppression included B-lymphocyte suppression with 4 weeks of MMF 1.0 g/day and MP 8 mg/day [8]. This protocol was modified for our patient group aged 60 years and older.…”

Section: Methodsmentioning

confidence: 99%

Clinical Outcome of Elderly Kidney Transplant Recipients from Spousal Donors

et al. 2015

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“…The number of spousal transplants is also increasing, accounting for about 40% of all living donor kidney transplants [2]. Previously, we demonstrated that ABO-incompatible living-unrelated donor kidney transplantation was equivalent to ABO-compatible living-related kidney transplantation at least in graft and patient survivals [3]. …”

Section: Introductionmentioning

confidence: 99%

“…Rituximab induces long-lasting B-cell depletion in the peripheral blood. Using rituximab, we have performed successful ABO-incompatible kidney transplants in recipients without splenectomy [3,5] as well as in those with high pretransplant anti-A/B antibody titers [6,7]. Most reports on the experience with rituximab in kidney transplantation have been made on ABO-incompatible transplantation, where low rates of acute rejection have been observed [8].…”

Section: Introductionmentioning

confidence: 99%

ABO-Incompatible Living Kidney Transplant Recipients from Spousal Donors Receiving Rituximab

Uchida

Iwai²,

Kabei³

et al. 2016

Urol Int

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Introduction: We summarized our experience with ABO-incompatible living kidney transplant recipients from spousal donors receiving rituximab. Patients and Methods: Between June 2006 and December 2014, 82 patients with end-stage renal disease underwent living donor kidney transplantation at Osaka City University Hospital, of which 23 cases were ABO-incompatible transplantation between spouses with rituximab induction. We analyzed these recipients, focusing on their immunosuppressive protocols, frequency of acute rejections, and patient/graft survivals. Results: Patient and graft survival rates were 100%. The incidence of acute cellular rejection (ACR) was 30.4%. One patient experienced antibody-mediated rejection (AMR) and intractable ACR, 2 had AMR, and 2 had intractable ACR episodes that were treated using thymoglobulin. Conclusions: This study demonstrated that ABO-incompatible kidney transplantation between spouses using rituximab is a radical but effective treatment for end-stage renal disease. However, this procedure could be immunologically high risk due to ABO-incompatibility and poor histocompatibility.

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“…Especially the transplantation of kidneys with ‘expanded criteria' and the Eurotransplant Senior Program have increased the number of older organs for DDRT [3]. Programs for AB0-incompatible living donor renal transplantation (LDRT) and cross-over LDRT have widened the possibility for LDRT [4,5,6]. Due to the shortage of organs, kidneys of deceased pediatric donors have been transplanted to adult recipients, although this remains a rare option.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Single Pediatric Deceased Donor Renal Transplantation to Adult Kidney Transplant Recipients

Friedersdorff

Fuller²,

Werthemann³

et al. 2013

Urol Int

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Introduction: In times of organ shortage more kidneys were transplanted in ‘expanded criteria kidney' programs. This study examines the outcome of adult kidney recipients from pediatric donors. Materials and Methods: This single-center retrospective analysis evaluated eight adult patients who received a kidney from a deceased pediatric donor (age 5-17) between 06/2000 and 09/2011. Results: The median donor age was 14 years (range 5-17). The median recipient age was 49 years (range 25-57). The median cold ischemia time was 13.3 h (range 4.3-20.1), while the median warm ischemia time was 53 min (range 42-60). The median follow-up was 35.8 months (range 7-142). Acute rejection was observed in 50.0% of cases. The median HLA mismatch was 2.0. The median 1-year creatinine level was 0.95 mg/dl, the uncensored 1-year graft survival was 75.0% and the 3-year graft survival 62.5%, respectively. No recipient died within the follow-up period. As severe surgical complications, one stenosis of the renal artery and one lymphocele needing surgical revision were observed. Conclusions: Renal transplantation of a deceased single pediatric donor to an adult recipient can be performed safely and shows a good outcome. Wherever feasible, single pediatric kidney transplantation can double the number of recipients over an ‘en-bloc' transplantation. The price for a single pediatric kidney transplant may be a higher vascular complication rate and a higher rejection risk. Despite the higher risks, transplantation of a single pediatric donor kidney should be performed when accomplishable.

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Clinical Outcome of ABO-Incompatible Living Unrelated Donor Kidney Transplantation

Cited by 15 publications

References 20 publications

Clinical Outcome of Elderly Kidney Transplant Recipients from Spousal Donors

Clinical Outcome of Elderly Kidney Transplant Recipients from Spousal Donors

ABO-Incompatible Living Kidney Transplant Recipients from Spousal Donors Receiving Rituximab

Outcome of Single Pediatric Deceased Donor Renal Transplantation to Adult Kidney Transplant Recipients

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