ABO-Incompatible Renal Transplantation

In an effort to overcome the severe organ shortage, ABO-incompatible kidney transplantation has been carried out in many transplant centers worldwide over the last decade. In the 1980s, ABOincompatible kidney transplantation was electively performed in Europe and Japan and the early results were acceptable though short-term results were significantly poorer than those of ABO-compatible kidney transplantation (80% vs. 95% at one year, 79% vs. 92% at three years in ABO-incompatible vs. ABOcompatible transplantations, respectively). The original preconditioning regimens included splenectomy, plasmapheresis, and immunosuppression with ciclosporin, azathioprine and steroids.

Early in this century, many potent immunosuppressive agents, such as tacrolimus, mycophenolate mofetil, rituximab, basiliximab, thymoglobulin and daclizimab were introduced in the field of clinical kidney transplantation. With these potent immunosuppressive agents, the outcomes of ABO-incompatible kidney transplantation improved significantly. Currently, in most transplant programs, preconditioning and immunosuppressive regimens typically include a rituximab injection, plasmapheresis or immunoadsorption and immunosuppression with tacrolimus, mycophenolate mofetil and steroids. The latter is a mild regimen comparable to those for ABO-compatible kidney transplantation. Recently, one year graft survival in most ABO-incompatible programs has exceeded 90-95%. Furthermore, the incidence of rejection is less than 10% in most reports of ABO-incompatible kidney transplantation.

ABO-incompatible kidney transplantation has become a safe, excellent treatment option for renal failure patients.

Keywords: ABO Incompatible Kidney Transplantation, Rituximab, Plasmapheresis, C4d, Acute Rejection, Living Donor, Organ Shortage, Desensitization.