Background: Organ shortage has led to an increase in living related kidney transplantation of ABO compatible (ABOc) as well as ABO incompatible (ABOi) organs. Here we report on our results of a matched-pair analysis of ABOi versus ABOc living related kidney transplantation. Patients and Methods: We have analyzed from 2009 until now 32 ABOi and 32 ABOc living related donations in a matched-pair analysis. Matching criteria were age of donor and recipient, gender, duration of preoperative dialysis, number of HLA mismatches and detection of donor specific antibodies. Immunosuppression consisted of tacrolimus, steroids and mycophenolat mofetil plus induction therapy with basiliximab. In addition, in the ABOi group all recipients were given rituximab preoperatively and they were treated with immunoadsorption or plasmapheresis until they reached isoagglutinin titers of IgG and IgM of <1:8 and <1:4, respectively. The follow up comprises a median of 30 ± 17 months. Results: All 64 patients were transplanted successfully with a median cold ischemia time in the ABOc group of 142.5 ± 23.6 minutes compared with 144.3 ± 27.1 minutes in the ABOi group (n.s.). Before transplantation patients in the ABOi group needed a median of 7.71 ± 5.87 immunoadsorptions and 2.71 ± 2.65 plasmaphereses until they reached the desired isoagglutinin titers. This resulted in a significantly longer preoperative hospitalization in the ABOi group (9.4 ± 7.1 days) in comparison with the ABOc group (1.34 ± 0.8 days) (p<0,05). Acute rejections were identical in both groups with nine patients each (28%), with 4 humoral rejections in ABOi patients and 1 in ABOc patients. 30 months after transplantations there is no significant difference in serum creatinine levels between both groups (ABOi 1,27 mg/dl, ABOc 1,31 mg/dl). Surgical and non-surgical complications were similar in both groups. Conclusions: Isoagglutinin titer controlled immunomodulation together with rituximab and standardized immunosuppression is a safe and successful regimen for living related ABOi kidney transplantation. Following this protocol our matched-pair analysis shows excellent results for ABOi donation immediately postoperatively as well as during follow up.

CITATION INFORMATION: Vowinkel T, Wolters H, Reuter S, Vogel T, Senninger N, Suwelack B. ABO Incompatible Living Related Kidney Transplantation: Results of a Matched-Pair Analysis with ABO Compatible Living Donation. Am J Transplant. 2016;16 (suppl 3).

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