This study describes the single center experience and long-term results of ABOincompatible kidney transplantation (ABO i KT).

Four hundred patientswhoreceived an ABOi KT in the period February 2009 to December 2016 at the Asan Medical Center were retrospectively reviewed. After we experienced lethal infectious complications in the first 89 patients (Era1), the pre-transplantation protocol was modified using a lower dose of rituximab (from 500 mg to 200 mg), selective use of calcineurin inhibitors (using cyclosporine in patients older than 55 years) and anti-metabolite reduction (from 1,500 mg/day to 1,000 mg/day), and a prophylactic strategy (Era 2).

The overall patient survival(PS) rates after ABO i KT at one, three, and five years were 97.9%, 97.4%, and 95.9%. The death censored graft survival(DCGS) rates at one, three, andfive years were 98.9%, 98.1%, and 97.7% and the rejection-free graft survival (RFGS) rates at one, three, andfive years were 91.4%, 85.0%, and 82.6%. The overall PS rates stratified by era showed a significant difference between Era 1 and Era 2 during the five-year follow-up (88.7% vs. 96.7%, P = 0.014) due to infectious complications. There was neither a significant difference in the five-year DCGS rates (Era 1 vs. Era 2; 98.9% vs. 97.8%, P = 0.85) and the five-year RFGS rates (Era 1 vs. Era 2; 85.6% vs. 82.2%, P = 0.34). Overall infectiouscomplications decreased significantly in Era 2 (48.4% vs. 33.9%, P = 0.035), including cytomegaloviremia (64.1% vs. 30.1%, P < 0.001) and BK viremia≥ 4 logs (15.6% vs. 11.3%, P= 0.08).

ABO-incompatible kidney transplantation can be performed safely witha successful graft outcome. The modification of immunosuppression according to host conditions is recommended for the prevention of infectious complications.

CITATION INFORMATION: Kwon H., Kim Y., Choi J., Shin S., Jung J., Cho M., Kim J., Han D. Optimal Protocol for ABO Incompatible Kidney Transplantations: Analysis of 400 Cases in a Single Center Experience Am J Transplant. 2017;17 (suppl 3).

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