title: ABO incompatible renal transplantation: a paradigm ready for broad implementation.
abstract: The requirements for potent immunosuppression coupled with the formidable risk of irreversible antibody-mediated rejection (AMR) have thus far limited the expansion of ABO incompatible (ABOi) kidney transplantation. We present a retrospective review of our single-center experience with 60 consecutive ABOi kidney transplants and describe the evolution of our treatment protocol to one that consists only of a brief escalation in immunosuppression without long-term B-cell suppression from splenectomy or anti-CD20. The 1-, 3-, and 5-year graft survival rates for the cohort were 98.3%, 92.9%, and 88.7%, respectively, which is comparable with United Network for Organ Sharing data for compatible live donor transplants. No instances of hyperacute rejection were observed, and no grafts were lost secondary to AMR. In fact, fewer than 15% of the patients experienced a clinical episode of AMR, and rejections were mild. Elimination of B-cell ablative therapies did not result in an increased incidence of AMR. Excellent graft function persists with a current median creatinine clearance of 60 mL/min. The findings of this study and the relatively simple therapeutic regimen used should facilitate widespread application of ABOi kidney transplantation resulting in one of the most rapid escalations in access to organs in the modern era of kidney transplantation.
authors.affiliation: Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA. rmonty@jhmi.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
authors.forename: Jayme E
authors.initials: JE
authors.lastname: Locke
authors.forename: Karen E
authors.initials: KE
authors.lastname: King
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Warren
authors.forename: Edward S
authors.initials: ES
authors.lastname: Kraus
authors.forename: Matthew
authors.initials: M
authors.lastname: Cooper
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Simpkins
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Singer
authors.forename: Zoe A
authors.initials: ZA
authors.lastname: Stewart
authors.forename: J Keith
authors.initials: JK
authors.lastname: Melancon
authors.forename: Lloyd
authors.initials: L
authors.lastname: Ratner
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Zachary
authors.forename: Mark
authors.initials: M
authors.lastname: Haas
mesh_terms: D000017:ABO Blood-Group System; D001402:B-Lymphocytes / Q000276:immunology; D001787:Blood Group Incompatibility / Q000453:epidemiology* / Q000628:therapy*; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006388:Hemagglutinins / Q000378:metabolism; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology; D008954:Models, Biological; D016377:Organ Transplantation / Q000706:statistics & numerical data*; D010956:Plasmapheresis; D017741:Survivors; D014181:Transplantation Immunology
chemical_list: D000017:ABO Blood-Group System; D006388:Hemagglutinins; D016756:Immunoglobulins, Intravenous