Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Diabetes is a growing public health problem, and diabetes kidney disease (DKD) is the most prevalent chronic kidney disease and the major cause of end-stage kidney disease (ESKD) worldwide. The data are clear that kidney transplantation is superior to remaining on dialysis for patients with diabetes. In Japan, due to the severe shortage of deceased donors, the number of ABO-incompatible kidney transplantation is currently increasing, accounting for more than 30% of all living donor kidney transplants. Although it is considered to be an immunologically high-risk procedure, excellent outcomes have been achieved. However, there have been no reports on ABO-incompatible kidney transplantation in patients with ESKD due to DKD. In this pilot study, we summarized our experience with ABO-incompatible kidney transplantation in ESKD patients with DKDs.
*Methods: We conducted a retrospective, observational study to investigate the clinical outcomes of ABO-incompatible kidney transplantation for patients with DKD at our institution from April 2011 to October 2017. A total of 14 recipients were enrolled in this study. As our present standard desensitization protocol to remove the anti-A/B antibodies, the patients underwent plasmapheresis prior to kidney transplantation until the antibody titers were less than 1:16. The patients received one or two doses of rituximab (150 mg/m2) prior to transplantation to inhibit antibody production. Pretransplant desensitization consisted of administration of 2 weeks or 4 weeks of mycophenolate mofetil 0.5-1.0 g/day or everolimus 1.5 g/day for B-cell lymphocyte suppression.
*Results: All 14 patients underwent successful kidney transplantation. Both overall patient and graft survival rates were 100%, 89.9%, and 89.9% at 1, 3, and 5 years, respectively. One patient died 20 months after transplantation with a functioning graft due to pancreas cancer. The other 13 patients did not experience graft loss or death after transplantation and maintained good graft functions. The mean estimated glomerular filtration rate was 44.8±12.1 ml/min/1.73m2. Two of the 14 patients (14.3%) developed biopsy-proven acute cellular rejection during the follow-up period, but no recipients underwent antibody-mediated rejection. The median observation period was 32.0 months (range 5-83 months).
*Conclusions: ABO-incompatible kidney transplantation may be an acceptable renal replacement therapy for ESKD patients with DKD.
To cite this abstract in AMA style:Uchida J, Kosoku A, Kabei K, Nishide S, Shimada H, Maeda K, Yoshikawa Y, Iwai T, Kuwabara N, Naganuma T, Kumada N, Takemoto Y, Nakatani T. Blood Group Incompatible Living Donor Kidney Transplantation in Patients with End-Stage Kidney Disease Due to Diabetes Kidney Disease [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/blood-group-incompatible-living-donor-kidney-transplantation-in-patients-with-end-stage-kidney-disease-due-to-diabetes-kidney-disease/. Accessed June 11, 2021.
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