title: ABO-incompatible kidney transplantation using both A2 and non-A2 living donors.
abstract: 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.
authors.affiliation: Division of Nephrology and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Gloor
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Lager
authors.forename: S Breanndan
authors.initials: SB
authors.lastname: Moore
authors.forename: Alvaro A
authors.initials: AA
authors.lastname: Pineda
authors.forename: Mary E
authors.initials: ME
authors.lastname: Fidler
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Larson
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Grande
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Schwab
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Griffin
authors.forename: Mikel
authors.initials: M
authors.lastname: Prieto
authors.forename: Scott L
authors.initials: SL
authors.lastname: Nyberg
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Velosa
authors.forename: Steven C
authors.initials: SC
authors.lastname: Textor
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Platt
authors.forename: Mark D
authors.initials: MD
authors.lastname: Stegall
mesh_terms: 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
chemical_list: D000017:ABO Blood-Group System; D007518:Isoantibodies