title: ABO incompatible living donor kidney transplantation in Korea: highly uniform protocols and good medium-term outcome.
abstract: The organ shortage is as serious in Korea as in other parts of the world. As about one-third of the potential living donors are ABO incompatible (ABOi), transplantation across the blood group barrier can help overcome this shortage. One hundred and twenty-five ABOi kidney transplantations (KTs) were performed between 2007 and 2010 in Korea. We collected the perioperative and follow-up data for 118 of these patients until September 2011. The preconditioning and immunosuppressive protocols were almost identical across the different transplant centers, with rituximab but no splenectomy; pre-transplant plasmapheresis (PP) with target anti-A/B titer 8 or 16 on transplant day, on-demand, rather than routine, post-transplant PP, and tacrolimus-based immunosuppressants. The number of patients and participating centers showed a rapid increase over time, and in 2010, ABOi KT (n = 79) comprised 10% of all the living donor KTs in Korea. The mean follow-up period was 21 months (range, 1-56 months). Sixteen (14%) patients developed acute rejection, and three of these had antibody-mediated rejection (AMR). Two-yr patient and graft survival were 99.2% and 97.5%, respectively. No graft was lost due to AMR. ABOi KT is rapidly expanding in Korea with excellent medium-term outcome and will help mitigate the organ shortage.
authors.affiliation: Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea.
authors.forename: Jin Min
authors.initials: JM
authors.lastname: Kong
authors.forename: Jeongmyung
authors.initials: J
authors.lastname: Ahn
authors.forename: Jae Beom
authors.initials: JB
authors.lastname: Park
authors.forename: Byung-Ha
authors.initials: BH
authors.lastname: Chung
authors.forename: Jaeseok
authors.initials: J
authors.lastname: Yang
authors.forename: Joong Kyung
authors.initials: JK
authors.lastname: Kim
authors.forename: Kyu Ha
authors.initials: KH
authors.lastname: Huh
authors.forename: Jong Man
authors.initials: JM
authors.lastname: Kim
mesh_terms: D000017:ABO Blood-Group System; D000293:Adolescent; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011379:Prognosis; D056910:Republic of Korea; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents
keywords: ABO incompatible; antibody-mediated rejection; kidney transplantation; outcome; protocol; rituximab