Background. The long-term benefits of ABO-I kidney transplantation in terms of adverse events due to severe immunosuppression immediately before transplantation remain unclear.

Patients and Methods. Between 2000 and 2005, 261 recipients, including 59 ABO-I and 202 ABO-compatible (ABO-C) recipients, received kidney transplants from living donors. During this era, all recipients received triplicate immunosuppressive regimens (FK/MMF/MP) and basiliximab. ABO-I recipients underwent plasmapheresis and splenectomy as B-cell-targeting therapies to decrease anti-blood type antibodies until [times]32 titers. We compared death-censored graft survival, patient death with functioning graft (DWFG), rate of acute rejection, and other adverse events such as infection, hypertension, and cardiovascular disease between ABO-I and ABO-C recipients more than 10-year follow-up.

Results. During the 10 years after renal transplantations, grafts were lost in 39 cases, including 29 ABO-C recipients and 10 ABO-I recipients (P=0.623). There was no significant difference in the death censored graft survival rate between the ABO-C and ABO-I groups according to the Kaplan-Meier analysis. Overall mortality (DWFG), infection, coronary artery disease, and malignancies were also not significantly different between the two groups. However, non-lethal cytomegalovirus (CMV) and adenovirus infections were more frequently observed in the ABO-I group than in the ABO-C group (CMV: 52.5% vs. 26.2%, respectively, P<0.001; adenovirus: 6.8% vs. 1.0%, respectively, P=0.009). Renal biopsies were performed in all patients in this study. Overall, rejections were equally observed in the ABO-C (76 cases [37.6%]) and ABO-I groups (22 cases [37.3%]; P=0.946). Antibody mediated rejection was more frequently observed in the ABO-I group (19 cases, 32.2%) than in the ABO-C group (37 cases, 18.3%; P=0.022). There was no significant difference in the pathological chronicity such as interstitial fibrosis and tubular atrophy, CNI toxicity, and chronic rejections.

Conclusions. During the 10-year follow-up, there was no significant difference in patient and graft mortality. Non-lethal CMV and adenovirus infections were more frequently seen in ABO-I recipients. We conclude that patient and graft qualities of ABO-I recipients are equivalent to those of ABO-C recipients even more than 10 years after kidney transplantation.

CITATION INFORMATION: Ishida H, Shimizu T, Okumi M, Unagami K, Omoto K, Tanabe K. A Comparative Study of Patient and Graft Qualities Between Abo-Compatible and -Incompatible Recipients More Than Ten Years After Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

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