Long-term outcome of ABO-incompatible living donor kidney transplantation based on antigen-specific desensitization. An observational comparative analysis.
BACKGROUND
ABO-incompatible living donor kidney transplantation based on specific conditioning has been successfully adopted by transplant centres worldwide. Excellent short-term results have been reported in small cohorts. However, long-term data and comparative analyses are still sparse. We report on the outcome of 40 consecutive ABO-incompatible living donor kidney transplant recipients and compare their clinical course to a control group of 43 ABO-compatible living donor transplant patients transplanted during the same time period.


METHODS
This is an observational single-centre analysis of 40 consecutive patients undergoing ABO-incompatible kidney grafting between April 2004 and April 2009, using a protocol of rituximab, antigen-specific immunoadsorption, intravenous immunoglobulin, basiliximab induction and oral triple immunosuppression with tacrolimus, mycophenolic acid and prednisone. Forty-three ABO-compatible kidney transplant recipients served as controls. The control group had also received basiliximab induction and an identical initial maintenance immunosuppression. The two groups were observed for an average of 39 and 19 months, respectively.


RESULTS
There was a significantly higher incidence of lymphoceles requiring surgical revisions in the ABO-incompatible group. However, this surgical complication did not affect patient or graft survival. Mean serum creatinine, estimated glomerular filtration rate and proteinuria did not differ between the two groups. Furthermore, ABO-incompatible and ABO-compatible patients had the same incidence of humoral and cellular rejections. Despite a more aggressive induction therapy, no differences in infectious or malignant complications were observed.


CONCLUSIONS
ABO-incompatible living donor kidney transplantation utilizing a combination of rituximab and antigen-specific immunoadsorption yielded results identical to ABO-compatible transplantation despite a significantly higher number of human leukocyte antigen mismatches.
Wilpert
Jochen
J
Renal Division, University Hospital Freiburg, Germany.
Fischer
Karl-Georg
KG
Pisarski
Przemyslaw
P
Wiech
Thorsten
T
Daskalakis
Michael
M
Ziegler
Anna
A
Neumann-Haefelin
Elke
E
Drognitz
Oliver
O
Emmerich
Florian
F
Walz
Gerd
G
Geyer
Marcel
M
D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000373:Agglutinins / Q000097:blood; D001787:Blood Group Incompatibility; D003888:Desensitization, Immunologic; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007163:Immunosorbent Techniques; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D000017:ABO Blood-Group System; D000373:Agglutinins