ABO-incompatible kidney transplantation using both A2 and non-A2 living donors.
BACKGROUND
Given the scarcity of cadaveric organs, efforts are intensifying to increase the availability of living donors. The current study assessed the feasibility of using ABO-incompatible living-donor kidneys to expand the donor pool.


METHODS
The authors performed 18 ABO-incompatible living-donor kidney transplants between May 1999 and April 2001. Ten patients received living-donor kidneys from A2 and eight patients received kidneys from non-A2 blood group donors. Immunosuppression consisted of Thymoglobulin antibody induction, tacrolimus, mycophenolate mofetil, and prednisone. Eight non-A2 and two A2 kidney recipients also received a pretransplant conditioning regimen of four plasmapheresis treatments followed by intravenous immunoglobulin and splenectomy at the time of transplantation. Antidonor blood group antibody titer was measured at baseline, pretransplant, at 1- to 3-month and 1-year follow-up, and at the time of diagnosis of antibody-mediated rejection.


RESULTS
No hyperacute rejection episodes occurred. One-year graft and patient survival rates in the 18 ABO-incompatible recipients were only slightly lower than those of 81 patients who received ABO-compatible kidney transplants during the same period (89% vs. 96% and 94% vs. 99%, respectively). Glomerular filtration rate and serum creatinine levels did not differ between the groups. Antibody-mediated rejection occurred in 28% of ABO-incompatible recipients, and was reversible with plasmapheresis, intravenous immunoglobulin, and increasing immunosuppression in all patients except one.


CONCLUSIONS
ABO-incompatible living donor kidney transplants can achieve an acceptable 1-year graft survival rate using an immunosuppressive regimen consisting of Thymoglobulin induction, tacrolimus, mycophenolate mofetil, and prednisone combined with pretransplant plasmapheresis, intravenous immunoglobulin, and splenectomy.
Gloor
James M
JM
Division of Nephrology and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Lager
Donna J
DJ
Moore
S Breanndan
SB
Pineda
Alvaro A
AA
Fidler
Mary E
ME
Larson
Timothy S
TS
Grande
Joseph P
JP
Schwab
Thomas R
TR
Griffin
Matthew D
MD
Prieto
Mikel
M
Nyberg
Scott L
SL
Velosa
Jorge A
JA
Textor
Steven C
SC
Platt
Jeffrey L
JL
Stegall
Mark D
MD
D000017:ABO Blood-Group System; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility / Q000503:physiopathology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007518:Isoantibodies / Q000032:analysis; D016030:Kidney Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D019172:Transplantation Conditioning
D000017:ABO Blood-Group System; D007518:Isoantibodies