title: Excellent long term patient and renal allograft survival after ABO-incompatible kidney transplantation: Experience of one center.
abstract: OBJECTIVE
  To investigate the long-term results of ABO-incompatible (ABOi) kidney transplantation in a single center in Greece.
  
  
  METHODS
  Thirty consecutive ABOi kidney transplantations were performed from June 2005 to December 2013. All patients received rituximab one month prior to transplantation. Immunoadsorption therapy was performed for the removal of anti-A/B IgG antibodies until the titer was ≤ 1:16. Additional apheresis sessions were performed post-operatively. Intravenous immunoglobulin and oral immunosuppression consisting of tacrolimus (TAC) in combination with either everolimus or mycophenolate acid was administered. We compared the long term results of our ABOi group to those of a matched group of 30 ABO compatible (ABOc) living kidney recipients with similar baseline characteristics. The ABOc recipients received an immunosuppressive regimen consisting of TAC and mycophenolate acid. All patients in both groups received induction therapy with Basiliximab or Daclizumab, whereas corticosteroids were instituted on the day of surgery. During the follow-up period, indication biopsies were performed and interpreted by an experienced nephropathologist. The parameters we analyzed included the following: Donor/recipient age, gender, blood type, human leukocyte antigen mismatches, panel reactive antibodies, primary cause of renal failure, mean time on dialysis, immunosuppressive regimen, patient survival, graft outcome, incidence of rejections, surgical and infectious complications.
  
  
  RESULTS
  The mean follow-up period was 6 years (range 1 to 9 years). A mean of 5.0 ± 3.0 (range 0-14) pre-transplant immunoadsorptions were required in order to reach the target titer. Patient survival in ABOi group in comparison to ABOc group at 1, 3, 5 and 8 years did not differ significantly (100% vs 100%, 96% vs 100%, 92% vs 100% and 92% vs 100%, P = ns). Additionally, graft survival was similar in the two groups at the same time points (100% vs 100%, 96% vs 96%, 92% vs 96% and 81% vs 92%, P = ns). The mean serum creatinine and the estimated glomerular filtration rate by the modification of diet in renal disease formula at 1, 3, 5 and 8 years did not differ significantly between ABOi and ABOc group. None of the patients in the ABOi group developed acute or chronic antibody-mediated rejection evidenced by histological signs. Four patients (13.3%) in the ABOi group and 3 (10%) in the ABOc group experienced acute cellular rejection, which was treated successfully in all cases. Bacterial and viral infections were also similar between the two groups.
  
  
  CONCLUSIONS
  ABOi kidney transplantation is a safe and effective alternative that enables kidney transplantation in countries with unacceptably long deceased-donor waiting lists.
authors.affiliation: Christina Melexopoulou, Smaragdi Marinaki, Chrysanthi Skalioti, John N Boletis, Nephrology Department and Renal Transplantation Unit, Laiko Hospital, 11527 Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Melexopoulou
authors.affiliation: Christina Melexopoulou, Smaragdi Marinaki, Chrysanthi Skalioti, John N Boletis, Nephrology Department and Renal Transplantation Unit, Laiko Hospital, 11527 Athens, Greece.
authors.forename: Smaragdi
authors.initials: S
authors.lastname: Marinaki
authors.affiliation: Christina Melexopoulou, Smaragdi Marinaki, Chrysanthi Skalioti, John N Boletis, Nephrology Department and Renal Transplantation Unit, Laiko Hospital, 11527 Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Liapis
authors.affiliation: Christina Melexopoulou, Smaragdi Marinaki, Chrysanthi Skalioti, John N Boletis, Nephrology Department and Renal Transplantation Unit, Laiko Hospital, 11527 Athens, Greece.
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Skalioti
authors.affiliation: Christina Melexopoulou, Smaragdi Marinaki, Chrysanthi Skalioti, John N Boletis, Nephrology Department and Renal Transplantation Unit, Laiko Hospital, 11527 Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Gavalaki
authors.affiliation: Christina Melexopoulou, Smaragdi Marinaki, Chrysanthi Skalioti, John N Boletis, Nephrology Department and Renal Transplantation Unit, Laiko Hospital, 11527 Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Zavos
authors.affiliation: Christina Melexopoulou, Smaragdi Marinaki, Chrysanthi Skalioti, John N Boletis, Nephrology Department and Renal Transplantation Unit, Laiko Hospital, 11527 Athens, Greece.
authors.forename: John N
authors.initials: JN
authors.lastname: Boletis
keywords: ABO-incompatible; Everolimus; Immunoadsorption; Kidney; Renal transplant; Transplantation