(Background) Although kidney transplantation is the most reassuring treatment for patients with end-stage renal disease (ESRD), shortage of organ donation in Japan is crucial. This issue has forced widening of indications for kidney transplantation. Therefore, ABO-incompatible living kidney transplantation (ABO-ILKT) has been a popular alternative to deceased kidney transplantation. In this retrospective single center study, we analyzed the long-term graft survival of ABO-incompatible living donor kidney transplant for over 20 years by comparing with ABO-compatible living kidney transplantation (ABO-CLKT) as control.
(Methods) In all, 1096 patients with ESRD underwent living donor kidney transplantation at our institute between 1989 and 2012. 263 cases were ABO-ILKT and 833 cases were ABO-CLKT. The mean age of ABO-ILKT group was 43.0 years (range 17 to 75), with 164 males and 99 females. Plasmapheresis and immunoadsorption were carried out to remove the anti-AB antibodies before the kidney transplantation. In the induction phase, most of the recipients received CNI (tacrolimus or cyclosporine)-based immunosuppression including methylprednisolone and mycophenolate mofetil. After 2002, all patients received basiliximab perioperatively. Between 1986 and 2004, splenectomy was performed at the time of ABO-ILKT. Thereafter, alternative to splenectomy, rituxamab was administered prior to ABO-ILKT. Log-rank testing was performed to determine differences in survival data.
(Results) Patient survival of ABO-ILKT at 1, 5, 10, 15, and 20 years post-transplant were 98, 97.5, 92.7, 87.1, and 87.1%, respectively. Graft survival of ABO-ILKT at 1, 5, 10, 15, and 20 years post-transplant were 90.8, 87.1, 71.7, 58.4, and 51.5%, respectively. Whereas, Graft survival of ABO-CLKT at 1, 5, 10, 15, and 20 years post-transplant were 97.5, 88.8, 76.4, 66.4, and 59.7%, respectively. Patient survival had no significant difference from that of ABO-CLKT (p=0.664). Although graft survival of ABO-ILKT at 20 years post-transplant had approximately 10% reduction from that of ABO-CLKT, there was no statistical difference between ABO-ILKT and ABO-CLKT (p=0.08).
(Conclusion) Despite receiving intensified desensitization protocol compared to ABO-CLKT, ABO-ILKT is an acceptable treatment for patients with ESRD in terms of patient survival and graft survival.
To cite this abstract in AMA style:Nozaki T, Ishida H, Shimizu T, Omoto K, Shirakawa H, Hirai T, Furusawa M, Tanabe K. Excellent Long-Term Outcome of ABO-Incompatible Living Donor Kidney Transplantation; a Single Center Experience for over 20 Years [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/excellent-long-term-outcome-of-abo-incompatible-living-donor-kidney-transplantation-a-single-center-experience-for-over-20-years/. Accessed December 6, 2023.
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