ABO blood group-incompatible living donor kidney transplantation: a prospective, single-centre analysis including serial protocol biopsies.
BACKGROUND
ABO incompatible kidney transplantation using antigen-specific immunoadsorption is increasingly performed but data on outcome, complications and protocol biopsies are still scarce. The present prospective single-centre study was aimed at these issues.


METHODS
This was a prospective single-centre cohort study of 10 successive ABO incompatible living donor kidney transplantations at the University Hospital Basel from September 2005 to October 2007. The following parameters were closely monitored during the whole follow-up: graft function, albuminuria, blood group antibody titres, CD19+ cell count, total IgG and IgG subclasses, CMV antigenaemia, decoy cells in the urine, EBV and polyoma BK virus PCR in the blood. Protocol biopsies were performed on Days 0 and 7 after 3, 6, 12 and 18 months.


RESULTS
Patient and graft survival is 100% after a median follow-up of 489 days (range 183-916 days). Median serum creatinine is 137 micromol/l (range 70-215 micromol/l), and median urine albumin-creatinine ratio (UACR) is 3.1 mg/ mmol (range 0.6-7.8 mg/mmol) at the time of the last follow-up. All patients had sustained diminished CD19+ cell count and/or total IgG concentrations. Neither CMV antigenaemia nor EBV replication in the blood was observed. Seven patients had positive polyoma BK virus replication in the blood but none developed polyoma virus-associated nephropathy (PVAN). Protocol biopsies revealed rejection Banff IIa in three patients on Day 7, and in one patient after 3 and 6 months. Banff Ia rejection was found in five patients. All rejection episodes resolved. Mild signs of chronic antibody-mediated rejection were observed in five patients.


CONCLUSIONS
ABO-incompatible kidney transplantation seems to be successful and safe. Modifications of the current protocol may be possible and may further reduce potential side effects and costs.
Oettl
Tobias
T
Clinic for Transplantation Immunology and Nephrology, University Hospital, Basel, Switzerland. oettlt@uhbs.ch
Halter
Joerg
J
Bachmann
Alexander
A
Guerke
Lorenz
L
Infanti
Laura
L
Oertli
Daniel
D
Mihatsch
Michael
M
Gratwohl
Alois
A
Steiger
Juerg
J
Dickenmann
Michael
M
D000017:ABO Blood-Group System; D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007163:Immunosorbent Techniques; D007518:Isoantibodies / Q000302:isolation & purification; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods / Q000473:pathology / Q000502:physiology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013557:Switzerland
D000017:ABO Blood-Group System; D007518:Isoantibodies