Excellent outcome of ABO-incompatible living kidney transplantation under pretransplantation immunosuppression with tacrolimus, mycophenolate mofetil, and steroid.
BACKGROUND
ABO-incompatible living kidney transplantation (LKT) has been performed to widen the indications for kidney transplantation. Since 2001, using a 7-day period of pretransplantation immunosuppression with tacrolimus (FK) plus mycophenolate mofetil (MMF) plus methylprednisolone (MP), we have observed a marked reduction in acute humoral/vascular rejection without any serious complications.


METHODS
Forty-five adult patients underwent ABO-incompatible LKT at our institute between January 2000 and September 2002. There were 20 men and 25 women of mean age 33 years. Plasmapheresis was performed to remove anti-AB antibodies prior to kidney transplantation. In 2000, 13 patients were treated with FK plus MMF plus MP without 7-day pretransplantation immunosuppression (group 1). Since January 2001, we have administered FK (0.1 mg/kg/d) plus MMF (1-2 g/d) plus MP (125 mg/d) concomitantly with plasmapheresis starting from 7 days before transplantation in 32 patients (group 2). Splenectomy was performed at the time of kidney transplantation in all patients.


RESULTS
Patient survival rate was 100% in both treatment groups. Graft survival rate was 92% and 97% in groups 1 and 2, respectively. One patient in group 1 lost the graft due to severe pancreatitis and 1 patient in group 2, due to severe humoral rejection. The incidence of acute rejection was 56% and 19% in group 1 and group 2, respectively. No patient experienced any lethal infectious complication.


CONCLUSIONS
Pretransplantation immunosuppression for 7 days using FK, MMF, and MP in ABO-incompatible LKT provides an excellent outcome without severe infectious complications.
Tanabe
K
K
Section of Renal Transplantation/Renovascular Surgery, Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. tanabe@kc.twmu.ac.jp
Tokumoto
T
T
Ishida
H
H
Ishikawa
N
N
Miyamoto
N
N
Kondo
T
T
Shimmura
H
H
Setoguchi
K
K
Toma
H
H
D000017:ABO Blood-Group System / Q000276:immunology; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001787:Blood Group Incompatibility; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D010290:Parents; D011300:Preoperative Care; D012189:Retrospective Studies; D035781:Siblings; D018454:Spouses; D016559:Tacrolimus / Q000627:therapeutic use*
D000017:ABO Blood-Group System; D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus