title: ABO blood type-incompatible kidney transplantation and access to organs.
abstract: OBJECTIVE
  To determine whether ABO-incompatible (ABOi) kidney transplantation can be performed safely and result in acceptable posttransplantation outcomes.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Transplantation center.
  
  
  METHODS
  In the 1&frac12; years of a new program, 18 patients with renal failure and an ABOi living kidney donor were included in the study. All donors and recipients were of incompatible blood types and underwent transplantation beginning in June 2008.
  
  
  METHODS
  Patients received immunomodulation (anti-CD20 antibody, intravenous immunoglobulin, and plasmapheresis) until an acceptable isoagglutinin titer was obtained on the date of transplantation. All the kidneys were transplanted heterotopically, and all the patients received induction immunosuppression followed by a combination of prednisone, mycophenolate mofetil, and tacrolimus. Isoagglutinin titers were monitored, and postoperative plasmapheresis was initiated if titers increased.
  
  
  METHODS
  Patient and allograft survival; length of stay; 1-, 3-, and 6-month and 1-year renal function; and incidence of rejection.
  
  
  RESULTS
  Patient survival was 100%, with allograft survival of 94.4%. Mean (SD) length of stay was 6.9 (1.9) days. Donor to recipient transplantation was A to O in 11 cases, A2 to B in 1, B to A in 3, B to O in 1, and AB to B in 2. Mean (SD) creatinine levels, a measure of graft function, were 1.2 (0.5) mg/dL at discharge, 1.4 (0.4) mg/dL at 1 month, 1.3 (0.45) mg/dL at 3 months, 1.1 (0.3) mg/dL at 6 months, and 1.2 (0.2) mg/dL at 1 year. One episode of cellular rejection occurred.
  
  
  CONCLUSIONS
  These short-term results suggest that with a straightforward regimen, ABOi kidney transplantation is possible, acceptable results and graft function are obtainable, and access to kidney transplantation for those with a blood type-incompatible donor can be expanded.
authors.affiliation: Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095-7054, USA. gLipshutz@mednet.ucla.edu
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Lipshutz
authors.forename: Suzanne
authors.initials: S
authors.lastname: McGuire
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhu
authors.forename: Alyssa
authors.initials: A
authors.lastname: Ziman
authors.forename: Rebecca
authors.initials: R
authors.lastname: Davis
authors.forename: Dennis
authors.initials: D
authors.lastname: Goldfinger
authors.forename: Elaine F
authors.initials: EF
authors.lastname: Reed
authors.forename: Alan H
authors.initials: AH
authors.lastname: Wilkinson
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Danovitch
authors.forename: Phuong-Thu
authors.initials: PT
authors.lastname: Pham
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000368:Aged; D018951:Antigens, CD20 / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000628:therapy; D006085:Graft Survival; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D015994:Incidence; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011446:Prospective Studies; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D018951:Antigens, CD20; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents