Landscape of ABO-Incompatible Live Donor Kidney Transplantation in the US

Mustian, Margaux N.; Cannon, Robert M.; MacLennan, Paul A.; Reed, Rhiannon D.; Shelton, Brittany A.; McWilliams, Deanna M; Deierhoi, Mark H.; Locke, Jayme E.

doi:10.1016/j.jamcollsurg.2017.12.026

Cited by 24 publications

(14 citation statements)

References 21 publications

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“…After the first successful ABO-ILKT by Alexandre et al, [11][12][13] ABO-ILKT has been widely performed worldwide. 8,[14][15][16] In Japan, ABO-ILKT becomes a routine procedure to deal with the shortage of kidney donors and accounts for approximately 30% of all LKT procedures. Patient and graft survival were 98% and 96%, respectively, for the first year, and 91% and 83%, respectively, at 9 years post-transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…States than in Europe and Japan. 20 The frequency of patients who underwent ABO-ILKT in 2015 represents 1.3% of all United States LKTs, 8 because ABO-ILKT is reported previously to be associated with higher rate of early complications and more expensive medical cost than ABO-CLKT.…”

Section: However Abo-ilkt Remains Much Less Common In the Unitedmentioning

confidence: 99%

“…6,7 The frequency of the patients who underwent ABO-ILKT in 2015 represents 1.3% of all US LKTs, 8 as ABO-ILKT recipients experience significantly more expensive in pre-transplant, transplant event, and post-transplant costs than ABO-CLKT recipients. 6,7 The frequency of the patients who underwent ABO-ILKT in 2015 represents 1.3% of all US LKTs, 8 as ABO-ILKT recipients experience significantly more expensive in pre-transplant, transplant event, and post-transplant costs than ABO-CLKT recipients.…”

mentioning

confidence: 99%

“…Despite these excellent outcomes and evidence of clinical success, ABO-ILKT remains a rare procedure in United States. 6,7 The frequency of the patients who underwent ABO-ILKT in 2015 represents 1.3% of all US LKTs, 8 as ABO-ILKT recipients experience significantly more expensive in pre-transplant, transplant event, and post-transplant costs than ABO-CLKT recipients. 9 Moreover, ABO-ILKT recipients appeared more likely to experience complications, such as wound infection, pneumonia, and urinary tract infection, than ABO-CLKT recipients.…”

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confidence: 99%

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Outcomes, complications, and economic impact of ABO‐incompatible living kidney transplantation: A single‐center Japanese cohort study

Kakuta

Okumi

Unagami

et al. 2019

Clinical Transplantation

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| INTRODUC TI ONABO-incompatible living kidney transplantation (ABO-ILKT) was initially considered to result in antibody-mediated rejection (ABMR) leading to graft loss. In 1987, however, successful ABO-ILKT was introduced in Japan, using pre-transplant antibody depletion. [1][2][3][4] Recently, ABO-ILKT has been performed as a routine practice and constituted nearly 30% of living kidney transplantation performed in Japan. The substantial improvements of ABO-ILKT were demonstrated in relation to the graft survival rate, the frequency of infectious adverse events, and renal function over time. We previously reported that the graft survival of patients who underwent LKT in the past decade was almost identical regardless of ABO incompatibility. 5 Abstract ABO-incompatible kidney transplantation (ABO-ILKT) has been reported to have a higher rate of early complications and higher medical costs than ABO-compatible kidney transplantation (ABO-CLKT). We aimed to compare the clinical outcomes, complications, and medical costs between ABO-ILKTs and ABO-CLKTs at 2 years post-transplantation. We included 65 ABO-ILKTs and 94 ABO-CLKTs in this retrospective analysis. The patient survival, graft survival, rejection incidence, and graft function were similar between ABO-CLKT and ABO-ILKT. The hospitalization costs for ABO-CLKT and ABO-ILKT were 26 544 ± 4168 USD and 34 906 ± 18 732 USD, respectively (P = 0.0001). Total 2-year medical costs were 77 117 ± 15 609 USD and 85 325 ± 33 997 USD for ABO-CLKT and ABO-ILKT, respectively, indicating that the medical costs of ABO-ILKT recipients were non-significantly higher than those of ABO-CLKT recipients at 2 years post-transplantation (P = 0.0866). ABO-ILKT and ABO-CLKT recipients showed similar infectious adverse events and complications. In conclusion, medical cost at 2 years post-transplantation, including transplant hospitalization cost, and the frequency of early complications were not significantly higherin the ABO-ILKT group than in the ABO-CLKT group. ABO-ILKT is an acceptable treatment for patients with ESRD and is comparable to ABO-CLKT not only in terms of outcomes but also in terms of medical cost.

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Section: Discussionmentioning

confidence: 99%

Section: However Abo-ilkt Remains Much Less Common In the Unitedmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Outcomes, complications, and economic impact of ABO‐incompatible living kidney transplantation: A single‐center Japanese cohort study

Kakuta

Okumi

Unagami

et al. 2019

Clinical Transplantation

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“…8 Nevertheless, data from Japan demonstrating successful long -term results of ABOi kidney transplantation combined with subsequent successful results from ABOi desensitization protocols in the United States have restored interest in this procedure. 9,10 Nowadays, graft survival of ABOi kidney transplantation recipients matches those of ABO compatible recipients. 6 In 2014 Oporto Hospital University Center started the ABOi kidney transplantation, using the recipient preconditioning protocols that had been used successfully in other European centers.…”

Section: Introductionmentioning

confidence: 99%

ABO-incompatible living donor kidney transplantation in Portugal

Ribeiro¹,

Silva²,

Malheiro³

et al. 2020

pjnh

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Introduction: ABO incompatibility was considered a barrier to kidney transplant. However, the shortage of available organs for transplantation and the excellent long-term results further establish ABO-incompatible (ABOi) as a safe and effective therapeutic strategy. The aim of the present study was to evaluate the outcomes of ABOi transplantation in terms of graft survival and function, rejection episodes and infections complications. Methods: The authors present a single-center retrospective observational study in a unit with approximately 370 living donor kidney transplants registered. This study includes the analysis of 12 patients who underwent ABOi living donor kidney transplantation between November 2014 and July 2019. Desensitization protocol consisted of intravenous Rituximab 375mg/m 2 single dose administration 2 weeks pretransplant. Tacrolimus and Mycophenolate Mofetil were started before transplantation one week and 48 hours respectively. Plasmapheresis was performed to remove anti-A or B antibodies until their titers were <1:8 during the first post-operative week and <1:16 at the second. All kidney recipients of both ABOi grafts received Basiliximab (20mg on days 0 and 4) as antibody induction therapy. Maintenance immunosuppression consisted of Tacrolimus, Mycophenolate Mofetil and corticosteroid. Results: A total of 12 patients were included in the study, 75% male; 43 years (IQR 31-50). The most common blood group mismatch was A to O (n=4; 33%). In the first year, 2 of patients (25%) developed acute rejection. The follow-up time was 17 months (IQR 7-36). Five patients (42%) developed infectious complications. None patients developed cytomegalovirus or BK polyomavirus infections. At the end graft and patient survival were 100%. Conclusion: ABOi kidney transplantation has become a routine procedure. With this approach, about 30% of living donors who were refused in the past can now donate their kidneys and thereby significantly expand the living donor pool. The immunosuppressive protocol of this unit can be considered safe.

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