J Korean Soc Transplant.  2012 Dec;26(4):261-268. 10.4285/jkstn.2012.26.4.261.

A Single Center Experience of ABO Incompatible Kidney Transplantation

• Chang CL
• Jeong JH
• Kim JP
• Lee DR
• Kong JM
• Kim BC

• KMID: 2202429
• DOI: http://doi.org/10.4285/jkstn.2012.26.4.261

Abstract

BACKGROUND
Kidney transplantation (KT) is the optimal treatment for end stage renal disease. However, the relative shortage of organs for transplantation (from human leukocyte antigen- or ABO incompatible [ABOi] living donors) has led to ABOi KT as an accepted method to expand the pool of living kidney donors. To date, reports of the outcomes of ABOi KT are limited; therefore this study aims to evaluate the outcomes of ABOi KT in recipients.
METHODS
We identified 45 patients who underwent live-donor ABOi KT between February 2007 and November 2011 at Maryknoll Medical Center. All of them were treated according to the scheduled protocol of plasmapheresis with low dose intravenous immunoglobulin, and low dose rituximab- or tacrolimus-based triple immunosuppressant regimens. Clinical parameters and the incidence of rejections in these patients were analyzed.
RESULTS
We had three cases (6.6%) of biopsy-proven acute antibody-mediated rejections and one case (2.2%) of acute cellular rejection, all of which were successfully treated. The median follow-up duration was 20 months (range, 2~59). Antibody depletion was scheduled according to baseline anti-ABO antibody titer (tube method: median immunoglobulin G titer/immunoglobulin M titer 64 [range, 8~4,096]/16 [range, 2~256], respectively). Although there was no patient death, one patient lost his graft due to nonadherence to immunosuppressants.
CONCLUSIONS
Our analysis of ABOi KT has shown excellent and promising outcomes. These practices may therefore represent an acceptable option for expanding the pool of living kidney donors.

Keyword

ABO incompatible kidney transplantation; Immunosuppression; Antibody mediated rejection

MeSH Terms

Follow-Up Studies
Humans
Immunoglobulin G
Immunoglobulins
Immunosuppression
Incidence
Kidney
Kidney Failure, Chronic
Kidney Transplantation
Leukocytes
Plasmapheresis
Rejection (Psychology)
Tissue Donors
Transplants
Immunoglobulin G
Immunoglobulins

Figure

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  Fig. 1 Kidney transplantation protocol. Abbreviations: PP, plasmapheresis; IVIG, intravenous immunoglobulin; FK, tacrolimus; MMF, mycophenolate mofetil; PD, methylprednisolon.

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  Fig. 2 Serial change of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody titer. Initial IgG/IgM antibody titer was 1:64/1:16, at the kidney transplantation (KT) was 1:2/1:1, and serial change of antibody titer after KT were 1:2/1:1 (1 week), 1:2/1:1 (2 weeks), 1:4/1:1 (3 weeks), 1:4/1:1 (1 month), 1:4/1:1 (3 month), 1:2/1:1 (6 month), 1:2/1:1 (1 year), and 1:2/1:1 (2 years).

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