title: ABO-incompatible kidney transplantation: long-term outcomes.
abstract: In the past 20 years, over 2,000 cases of ABO-incompatible living kidney transplantation (ABO-ILKT) have been performed in Japan, expanding the donor pool and overcoming the serious shortage of organ donors. Overall long-term outcomes (>20 years) have been excellent and almost identical to the outcomes of ABO-compatible living kidney transplantation (ABO-CLKT). In the last decade, ABO-ILKT has become accepted as a therapeutic alternative for end-stage renal failure. Recently, approximately 30% of all living donor kidney transplantations in Japan have been ABO-ILKT. In the 1990s, desensitization included preoperative plasmapheresis, splenectomy, and heavy immunosuppression that caused surgical and medical stress on patients and a higher cost than that needed for ABO-CLKT for the preoperative conditioning. However, since 2000, rituximab has replaced splenectomy making ABO-ILKT much easier. It is also less stressful for patients. In the last decade, outcomes have improved significantly and 5- and 10-year graft survival have reached 95% and 90%, respectively-identical to, or even better than outcomes of ABO-CLKT. Our current preconditioning includes plasmapheresis 0-2 times, rituximab injection, and regular immunosuppression. Neither intravenous immunoglobulin nor prophylactic plasmapheresis is used after transplantation. ABO-ILKT is a standard option for kidney transplantation requiring minimal preconditioning and regular immunosuppression after transplantation. It now provides an excellent long-term (>20 years) outcome.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishida
authors.forename: Masashi
authors.initials: M
authors.lastname: Inui
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Okumi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shirakawa
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Shimizu
authors.forename: Kazuya
authors.initials: K
authors.lastname: Omoto
authors.forename: Tsunenori
authors.initials: T
authors.lastname: Kondo
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology*; D003888:Desensitization, Immunologic / Q000379:methods*; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality*; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000276:immunology / Q000627:therapeutic use; D007239:Infections / Q000453:epidemiology / Q000276:immunology; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods / Q000401:mortality*; D009369:Neoplasms / Q000453:epidemiology / Q000276:immunology; D012307:Risk Factors
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents