Multicentre trial of ABO-incompatible kidney transplantation

Abstract

A multicentre study of ABO incompatible kidney transplantation using Biosynsorb was started in Japan in November 1989. A total of 51 cases were registered comprising 23 cases of A incompatibility, 26 cases of B incompatibility and two cases of AB incompatibility. The .removal of antibodies (IgG and lgM) was carried out using Biosynsorb in 16 cases, plasmapheresis in four cases and use of both combined in 31 cases. The treatment using Biosynsorb was repeated 3.4 times on average. Serum titres of anti-A (IgG and lgM) antibodies decreased to 4.9 ± 5.0 and 2.7 ± 1.7 and for anti-B titres decreased to 2.8 ± 3.5 and 2.4 ± 3.2. Rejection was found in 33 cases: hyperacute one, accelerated acute five, and acute 27. In two cases rejection was developed concomitantly with a steep elevation in antibody titres. Three patients died, two with functioning grafts. Eight grafts were lost. Patient and graft survivals at 2 years were 94.1% and 84.3%, respectively. From these results it is concluded that: 1. Biosynsorb and plasmapheresis are effective in removing anti-A and anti-B antibodies; 2. graft and patient survivals are similar to those in ABO compatible cases; 3. anti-A and anti-B titres less than 16 are recommended at the time of transplantation; 4. anti-A and anti-B titres higher than 128 may be considered as a risk factor for rejection in the early stages after transplantation.

Excellent Long-term Outcome of ABO-Incompatible Living Donor Kidney Transplantation in Japan

“…In Japan up to three sessions of plasmapheresis after ABO‐incompatible kidney transplantation are covered by National Health Insurance. The results in the 51 patients who underwent transplantation after antibody removal by immunoadsorption with Biosynsorb ® have been reported previously (12).…”

“…Immunoadsorption with Biosynsorb ® (Unicom Corporation, Tokyo, Japan) was carried out in 51 of 441 patients (2,3,6,10–12). Subsequently, production of Biosynsorb ® was discontinued, and only plasmapheresis was used to remove antibodies before transplantation.…”

Weak expression of blood type B antigen in kidney tissue and successful B-incompatible kidney transplantation without special treatments

“…In our reported case, the preoperative depletion of natural antibody and splenectomy were intentionally avoided. Ota et al [9] reported the results of 51 cases and recommended a reduction of antibody titers below 16 at the time of transplantation for a successful outcome. Although this patient showed a high titer of natural antibody against B antigen before transplantation, the titer dropped just after transplantation and maintained at low level thereafter.…”

“…Removal of the anti-A or anti-B antibodies of the recipients by plasmapheresis or immunoadsorption has become an essential treatment for kidney transplantation across the ABO barrier [2-41. As a result, graft and patient survival are nearly equal to those of ABOcompatible transplantation [9]. However, discussions have been focused on only the anti-A or anti-B antibody titer of the recipient, and quantitative evaluation of ABO antigens in the kidney tissue of the donor has been neglected.…”

ABO-incompatible kidney transplantation in Japan

“…For these reasons, we have been making continuous efforts in ABO-incompatible kidney transplantation since 1989 to expand the opportunities for living kidney transplantation in Japan [1][2][3][4][5][6]. The Japanese ABO-incompatible kidney transplantation committee had started the registry since 1997 [5,6].…”