title: The First Fifty ABO Blood Group Incompatible Kidney Transplantations: The Rotterdam Experience.
abstract: This study describes the single center experience and long-term results of ABOi kidney transplantation using a pretransplantation protocol involving immunoadsorption combined with rituximab, intravenous immunoglobulins, and triple immune suppression. Fifty patients received an ABOi kidney transplant in the period from 2006 to 2012 with a follow-up of at least one year. Eleven antibody mediated rejections were noted of which 5 were mixed antibody and cellular mediated rejections. Nine cellular mediated rejections were recorded. Two grafts were lost due to rejection in the first year. One-year graft survival of the ABOi grafts was comparable to 100 matched ABO compatible renal grafts, 96% versus 99%. At 5-year follow-up, the graft survival was 90% in the ABOi versus 97% in the control group. Posttransplantation immunoadsorption was not an essential part of the protocol and no association was found between antibody titers and subsequent graft rejection. Steroids could be withdrawn safely 3 months after transplantation. Adverse events specifically related to the ABOi protocol were not observed. The currently used ABOi protocol shows good short and midterm results despite a high rate of antibody mediated rejections in the first years after the start of the program.
authors.affiliation: Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus Medical Center, D414, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Madelon
authors.initials: M
authors.lastname: van Agteren
authors.affiliation: Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus Medical Center, D414, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
authors.affiliation: Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus Medical Center, D414, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Annelies E
authors.initials: AE
authors.lastname: de Weerd
authors.affiliation: Department of Hematology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Peter A W
authors.initials: PA
authors.lastname: Te Boekhorst
authors.affiliation: Department of Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
authors.affiliation: Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus Medical Center, D414, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Jaqueline
authors.initials: J
authors.lastname: van de Wetering
authors.affiliation: Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus Medical Center, D414, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Michiel G H
authors.initials: MG
authors.lastname: Betjes