title: Successful results after 5 years of tacrolimus therapy in ABO-incompatible kidney transplantation in Japan.
abstract: In Japan, living donor kidney transplantation accounts for about 80% of all kidney transplants. This is in contrast to the United States and Europe, where transplantation of organs from cadaveric or brain-dead donors is more common. This study analyzed the results of 5 years of experience with tacrolimus in Japan, focusing on the efficacy of the drug in improving patient and graft survival in patients who underwent transplantation with ABO-incompatible kidney grafts. Of the 1542 evaluable patients, 1281 patients received grafts from living donors. Of these, 177 patients received kidneys from ABO-incompatible donors and 981 patients received kidneys from ABO-compatible donors. Graft survival rates in ABO-incompatible recipients ranged from 90.7% at 1 year to 80.5% at 5 years. Subsequent graft survival rates in ABO-compatible recipients were 98.1% and 92.9%, respectively (P < .001 between groups). Patient survival rates at 5 years were 93.2% in ABO-incompatible recipients and 98.1% in ABO-compatible recipients. The rejection rate for kidneys from ABO-compatible donors was 27.8%, while for ABO-incompatible donors the rejection rate was 45.2%. The excellent outcome from this study demonstrates that even suboptimal ABO-incompatible donors can be used successfully as a source of kidneys when using tacrolimus as the immunosuppressive regimen. This may go some way to addressing the shortage of kidney donors in Japan.
authors.affiliation: Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University School of Medicine, Asahimach, Niigata, Japan. kota@med.niigata-u.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Takahashi
authors.forename: S
authors.initials: S
authors.lastname: Takahara
authors.forename: K
authors.initials: K
authors.lastname: Uchida
authors.forename: N
authors.initials: N
authors.lastname: Yoshimura
authors.forename: H
authors.initials: H
authors.lastname: Toma
authors.forename: S
authors.initials: S
authors.lastname: Oshima
authors.forename: T
authors.initials: T
authors.lastname: Sonoda
mesh_terms: D000017:ABO Blood-Group System; D001787:Blood Group Incompatibility; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use*; D007564:Japan; D016030:Kidney Transplantation / Q000276:immunology*; D012189:Retrospective Studies; D016559:Tacrolimus / Q000097:blood / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D016559:Tacrolimus