title: One hundred ABO-incompatible kidney transplantations between 2004 and 2014: a single-centre experience.
abstract: ABO-incompatible kidney transplantation (ABOi KTx) expands the living donor transplantation options. However, long-term outcome data, especially in comparison with ABO-compatible kidney transplantation (ABOc KTx), remain limited. Since the first ABOi KTx in Germany on 1 April 2004 at our centre, we have followed 100 ABOi KTx over up to 10 years.
  
  
  
  One hundred ABOi KTx and 248 ABOc KTx from 1 April 2004 until 28 October 2014 were analysed in this observational, single-centre study. Three ABOi KTx and 141 ABOc KTx were excluded because of cyclosporine A-based immunosuppression, and 1 ABOc KTx was lost to follow-up.
  
  
  
  Median estimated 10-year patient and graft survival in ABOi KTx was 99 and 94%, respectively, and surpassed ABOc-KTx patient and graft survival of 80 and 88%, respectively. The incidence rate of antibody-mediated rejections was 10 and 8%, and that of T-cell-mediated rejections was 17 and 20% in ABOi KTx and ABOc KTx, respectively. Infectious and malignant complications in ABOi KTx were not more common than in ABOc KTx. However, postoperative lymphoceles occurred more frequently in ABOi KTx. Subgroup analysis of ABOi-KTx patients revealed that patients with high-titre isohaemagglutinins before transplantation had equal long-term results compared with low-titre isohaemagglutinin patients.
  
  
  
  Taken together, long-term outcome of ABOi KTx is not inferior to ABOc KTx. Incidences of rejection episodes, infectious complications and malignancies are not increased, despite the more vigorous immunosuppression in ABOi KTx. Our data provide further evidence that ABOi KTx with living donation is a safe, successful and reasonable option to reduce the organ shortage.
authors.affiliation: Renal Division, Department of Medicine, University Medical Centre Freiburg, Freiburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Zschiedrich
authors.affiliation: Department of General and Digestive Surgery, University Medical Centre Freiburg, Freiburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Jänigen
authors.affiliation: Renal Division, Department of Medicine, University Medical Centre Freiburg, Freiburg, Germany.
authors.forename: Dilyana
authors.initials: D
authors.lastname: Dimova
authors.affiliation: Renal Division, Department of Medicine, University Medical Centre Freiburg, Freiburg, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Neumann
authors.affiliation: Institute for Pathology, University Medical Centre Freiburg, Freiburg, Germany Centre for Chronic Immunodeficiency, University Medical Centre Freiburg, Freiburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Seidl
authors.affiliation: Department of General and Digestive Surgery, University Medical Centre Freiburg, Freiburg, Germany.
authors.forename: Silvia
authors.initials: S
authors.lastname: Hils
authors.affiliation: Department of Nephrology and Dialysis, Hegau-Bodensee-Klinikum, Singen, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Geyer
authors.affiliation: Institute for Cell and Gene Therapy, University Medical Centre Freiburg, Freiburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Emmerich
authors.affiliation: Medical Faculty, Albert-Ludwigs-University Freiburg, Freiburg, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Kirste
authors.affiliation: Department of General, Visceral and Vascular Surgery, St Vincentius-Kliniken, Karlsruhe, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Drognitz
authors.affiliation: Department of General and Digestive Surgery, University Medical Centre Freiburg, Freiburg, Germany.
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
authors.affiliation: Renal Division, Department of Medicine, University Medical Centre Freiburg, Freiburg, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Walz
authors.affiliation: Renal Division, Department of Medicine, University Medical Centre Freiburg, Freiburg, Germany BIOSS Centre for Biological Signalling Studies, Albert-Ludwigs-University Freiburg, Freiburg, Germany.
authors.forename: Tobias B
authors.initials: TB
authors.lastname: Huber
authors.affiliation: Department of General and Digestive Surgery, University Medical Centre Freiburg, Freiburg, Germany.
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Pisarski
authors.affiliation: Renal Division, Department of Medicine, University Medical Centre Freiburg, Freiburg, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Kramer-Zucker
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility / Q000276:immunology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007239:Infections / Q000453:epidemiology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System
keywords: ABO-incompatible kidney transplantation; complications; high-titre isohaemagglutinin patients; long-term outcome; rejections