title: Clinical outcome and accommodation in ABO incompatible kidney transplantation.
abstract: We performed 84 ABO-incompatible kidney transplants at Toho University since 1989, with plasmapheresis and exchange replacing AB blood group plasma as pre-conditioning to reduce anti-donor blood group antibodies. Our current immunosuppression protocol consists of basiliximab, MMF, steroid, and cyclosporine or tacrolimus, including splenectomy. Overall patient/ graft survival rates (n=84) were 95/93 at one year, 94/92 at 3 years, 87/80 at 5 years, 87/75 at 7 years, and 83/67 at 10 years. The outcomes are similar to those of ABO-compatible living donor transplants. We have achieved 100% graft and patient survival rates (n=48) for the 7 years since January 1997. Our findings suggest that post-conditioning is not necessary to control titers of anti-donor blood group antibodies or to overcome acute humoral rejection. Infection control is critical in achieving good outcomes in ABO-incompatible transplants. We found that only anti-donor blood group antibodies in blood group O recipients of ABO-incompatible kidneys were specifically suppressed one year after transplantation. This appeared to be a type of accommodation in which there was no immunological response despite the co-existence of donor antigen and antibody, and might have been caused by down-regulation of B cells to produce anti-donor antibody.
authors.affiliation: Department of Nephrology, Toho University School of Medicine, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Aikawa
authors.forename: Takehiro
authors.initials: T
authors.lastname: Ohara
authors.forename: Kenji
authors.initials: K
authors.lastname: Arai
authors.forename: Tomomi
authors.initials: T
authors.lastname: Hadano
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kawamura
authors.forename: Ken
authors.initials: K
authors.lastname: Sugiyama
authors.forename: Masaki
authors.initials: M
authors.lastname: Muramatsu
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Itabashi
authors.forename: Naoko
authors.initials: N
authors.lastname: Kawada
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kanai
authors.forename: Akira
authors.initials: A
authors.lastname: Hasegawa
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy; D007518:Isoantibodies / Q000097:blood; D007564:Japan / Q000453:epidemiology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D019172:Transplantation Conditioning; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D007518:Isoantibodies