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

Abstract

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.

Therapeutic apheresis in ABO‐incompatible kidney and liver transplantation: A single‐center experience of 50 patients

“…Results of a study showed that ABO‐incompatible kidney transplantation is a safe and effective therapeutic strategy. The long‐term patient and graft survival rates are excellent and do not differ significantly from the control group 38 . Takahashi et al also found that rates of graft survival in recipients of ABO‐incompatible living kidney transplants are similar to those in recipients of ABO‐compatible grafts and that transplantation of ABO‐incompatible kidneys from living donors is a radical, but effective treatment for ESRD 39 .…”

“…The long-term patient and graft survival rates are excellent and do not differ significantly from the control group. 38 Takahashi et al also found that rates of graft survival in recipients of ABO-incompatible living kidney transplants are similar to those in recipients of ABO-compatible grafts and that transplantation of ABO-incompatible kidneys from living donors is a radical, but effective treatment for ESRD. 39 Sivakumaran et al concluded that there did not seem to be any association between donor and recipient ABO type in relation to ABMR.…”

Current protocols and outcomes of ABO-incompatible kidney transplantation

“…All of these findings on the higher mortality rate in transplants involving ABOi, probably related to the side effects of high immunosuppression are in favor of tailored immunosuppression. Indeed, some studies in which selected patients received a lower, tailored desensitization therapy reported an improved survival rate, with fewer infections and without ABMR[ 52 - 54 ].…”