ABO-incompatible kidney transplantation.
Owing to the shortage of deceased donors in Japan, since 1989, we have performed ABO-incompatible kidney transplantation (ABO-IKTx) to expand the indication for living donor kidney transplantation. During the past two decades, about 2000 ABO-IKTxs were performed. Since 2001 the success rate for these kidney transplants has reached 96% for 1-year, 91% for 5-year and 83% for 9-year graft survival, similar to outcomes of ABO-compatible kidney transplantation (ABO-CKTx). This dramatic improvement in results means that ABO-IKTx has become accepted as a therapeutic alternative for end-stage renal failure. Today ABO-IKTx accounts for approximately 30% of all living donor kidney transplantations performed in Japan. We have been making a lot of efforts to elucidate the mechanism of acute antibody-mediated rejection in ABOI-KTx in order to overcome the ABO barrier and to improve the outcome. From careful and precise clinical observations, proteomic analysis of ABO histo-blood group antigens in graft endothelial cells and deep insight into immunology and biology, we have reached the hypothesis that the structural difference of ABO histo-blood group antigens and de novo corresponding antibody production would be the key and keyhole of the development of acute AMR in ABOI-KTx. Preoperative desensitization therapy would be the best solution for the suppression of acute AMR and graft loss, which is now widespread and improves the outcome.
Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan. kota@med.niigata-u.ac.jp
Kota
K
Takahashi
Kazuhide
K
Saito
D000017:ABO Blood-Group System / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology*; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods*; D019520:Living Donors
D000017:ABO Blood-Group System