title: ABO-incompatible kidney transplantation in elderly patients over 60 years of age.
abstract: BACKGROUND
  Patients aged 60 years and older represent the fastest-growing population with end-stage renal disease worldwide, and the need for a kidney transplant among this population is increasing. Due to the severe shortage of deceased donors in Japan, ABO-incompatible living donor kidney transplantation has been performed since the late 1980s. Excellent long-term outcomes have been achieved, and the rates of graft survival in these patients are currently similar to those in recipients of ABO-compatible grafts. However, the outcomes of ABO-incompatible kidney transplantation in elderly patients over 60 years of age have not been well studied yet.
  
  
  METHODS
  We studied 4 elderly kidney transplant patients who received their grafts from ABO-incompatible living donors at our institution between December 2006 and December 2011, focusing on the immunosuppressive protocols, complications and graft survivals. The mean observation period was 21.5 months (range, 8 months to 62 months). Our immunosuppressive protocols were as follows: to remove the anti-A/B antibodies, the patients underwent 4-8 sessions of double-filtration plasmapheresis and/or plasma exchange prior to kidney transplantation until the anti-A/B titers were less than 1:16. For the patients with low anti-A/B titers (<1:512), the immunosuppressive protocol consisted of a single dose of rituximab (150 mg/m(2)). The patients with high anti-A/B antibody titers (≥1:512) underwent splenectomy and received 2 doses of rituximab. The pretransplant immunosuppressive protocol included B-lymphocyte suppression with 4 weeks of mycophenolate mofetil (0.5 g/day for low-titer protocol and 1 g/day for high-titer protocol).
  
  
  RESULTS
  All 4 patients underwent successful transplantation. At the end of follow-up, their mean serum creatinine was 1.18 mg/dl. No patient experienced antibody-mediated rejection or acute cellular rejection. Late-onset neutropenia occurred in two cases. Two cases experienced cytomegalovirus reactivation by cytomegalovirus antigenemia. In one patient, diffuse hemorrhage required surgical intervention. However, there were no severe complications.
  
  
  CONCLUSIONS
  Although a careful evaluation of patients is needed, ABO-incompatible kidney transplantation may become a viable treatment option for elderly patients with end-stage renal disease.
authors: Department of Urology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. m9492120@msic.med.osaka-cu.ac.jp
authors: Junji
authors: J
authors: Uchida
authors: Tomoaki
authors: T
authors: Iwai
authors: Yuichi
authors: Y
authors: Machida
authors: Nobuyuki
authors: N
authors: Kuwabara
authors: Kazuya
authors: K
authors: Kabei
authors: Masaki
authors: M
authors: Murao
authors: Taiyo
authors: T
authors: Otoshi
authors: Toshihide
authors: T
authors: Naganuma
authors: Norihiko
authors: N
authors: Kumada
authors: Tatsuya
authors: T
authors: Nakatani
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D001787:Blood Group Incompatibility; D003587:Cytomegalovirus / Q000502:physiology; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007564:Japan; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D009503:Neutropenia / Q000209:etiology; D010951:Plasma Exchange; D010956:Plasmapheresis; D000069283:Rituximab; D013156:Splenectomy; D019737:Transplants / Q000600:supply & distribution; D014775:Virus Activation / Q000276:immunology
chemical_list: D000017:ABO Blood-Group System; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab; D009173:Mycophenolic Acid