ABO-incompatible Kidney Transplantation: Long-Term Outcomes.
Tanabe K, Ishida H, Inui M, Okumi M, Shirakawa H, Shimizu T, Omoto K, Kondo T.
Clinical Transplants 2013, Chapter 36
In the past 20 years, over 2,000 cases of ABO-incompatible living kidney transplantation (ABO-ILKT) have been performed in Japan, expanding the donor pool and overcoming the serious shortage of organ donors. Overall long-term outcomes (>20 years) have been excellent and almost identical to the outcomes of ABO-compatible living kidney transplantation (ABO-CLKT). In the last decade, ABO-ILKT has become accepted as a therapeutic alternative for end-stage renal failure. Recently, approximately 30% of all living donor kidney transplantations in Japan have been ABO-ILKT. In the 1990s, desensitization included preoperative plasmapheresis, splenectomy, and heavy immunosuppression that caused surgical and medical stress on patients and a higher cost than that needed for ABO-CLKT for the preoperative conditioning. However, since 2000, rituximab has replaced splenectomy making ABO-ILKT much easier. It is also less stressful for patients. In the last decade, outcomes have improved significantly and 5- and 10-year graft survival have reached 95% and 90%, respectively-identical to, or even better than outcomes of ABO-CLKT. Our current preconditioning includes plasmapheresis 0-2 times, rituximab injection, and regular immunosuppression. Neither intravenous immunoglobulin nor prophylactic plasmapheresis is used after transplantation. ABO-ILKT is a standard option for kidney transplantation requiring minimal preconditioning and regular immunosuppression after transplantation. It now provides an excellent long-term (>20 years) outcome.