Long-Term Excellent Results of ABO-Incompatible Kidney Transplantations at Multicenter Japanese Case Series

K. Tanabe,^１ H. Ishida,^１ K. Masutani,² Y. Okabe,³ M. Okumi,¹ H. Kitada,² T. Shimizu,⁴ H. Shirakawa.⁵

¹Urology, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
²Kyushu University, Fukuoka, Japan
³Surgery, Harasanshin Hospital, Fukuoka, Japan
⁴Urology, Todachuo General Hospital, Toda, Saitama, Japan
⁵Urology, Ohkubo Hospital, Shinjuku, Tokyo, Japan.

Meeting: 2015 American Transplant Congress

Abstract number: 195

Keywords: CD20, Immunoadsorption, Kidney transplantation, Plasmapheresis

Session Information

Session Name: Concurrent Session: Kidney: Desensitization

Session Type: Concurrent Session

Date: Monday, May 4, 2015

Session Time: 2:15pm-3:45pm

Presentation Time: 2:51pm-3:03pm

Location: Terrace I-III

[Background]

Although kidney transplantation (KT) is the most reassuring treatment for patients with ESRD, shortage of organ donation in Japan is crucial. This issue has forced widening of indications for KT. Therefore, ABO-incompatible living kidney transplantation (ABO-ILKT) has been a popular alternative to deceased KT. In this retrospective multiple center study between 1996 and 2014, we analyzed the long-term graft survival of ABO-ILKT for over 15 years by comparing with ABO-compatible LKT (ABO-CLKT) as control.

[Methods]

In all, 1554 patients with ESRD underwent LKT at four institutes between 1996 and 2014. 435 cases were ABO-ILKT and 1119 cases were ABO-CLKT. Plasmapheresis and immunoadsorption were carried out to remove anti-AB antibodies before KT. In the induction phase, most of the recipients received tacrolimus or cyclosporine-based immunosuppression including methylprednisolone and mycophenolate mofetil. After 2002, all patients received basiliximab perioperatively. Between 1996 and 2004, splenectomy was performed at the time of ABO-ILKT. Thereafter, alternative to splenectomy, rituxamab was administered prior to ABO-ILKT. In ABO-ILKT, prophylactic plasmapheresis was not performed post-operatively, regardless of rebound titers.

[Results]

Patient survival of ABO-ILKT at 1, 5, 10 and 15 years post-transplant were 99.8, 98.6, 92.7, 98.6, and 94.7 %, respectively. Graft survival of ABO-ILKT at 1, 5, 10 and 15 years post-transplant were 96.3, 91.5, 84.7, and 75.8%, respectively. Whereas, graft survival of ABO-CLKT at 1, 5, 10 and 15 years post-transplant were 98.9, 91.5, 84.7 and 75.8%, respectively. Patient survival and graft survival had no significant difference from that of ABO-CLKT (p=0.096 and p=0.384). Graft biopsies showed significantly higher incidence rate of AMR within 6 months of ABO-ILKT (p<0.001). However, there were no significant differences in any type of rejections and graft function evaluated by sCr between both at any time points during the observation periods.

[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:

Tanabe K, Ishida ^１H, Masutani ^１K, Okabe Y, Okumi M, Kitada H, Shimizu T, Shirakawa H. Long-Term Excellent Results of ABO-Incompatible Kidney Transplantations at Multicenter Japanese Case Series [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/long-term-excellent-results-of-abo-incompatible-kidney-transplantations-at-multicenter-japanese-case-series/. Accessed May 17, 2025.

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