title: Histological and Extended Clinical Outcomes After ABO-Incompatible Renal Transplantation Without Splenectomy or Rituximab.
abstract: Excellent short-term results have been reported in ABO-incompatible (ABOi) renal transplant recipients managed solely with antibody removal and conventional immunosuppression. However, long-term clinical outcomes with this regimen and predictive information from protocol biopsies are lacking.
  
  
  
  We compared outcome data in ABOi and ABO-compatible (ABOc) recipients receiving this regimen approximately 4 years posttransplant, and histology from biopsies approximately 12 months posttransplant.
  
  
  
  Patient and graft survivals among 54 ABOi recipients were 98.1% and 90.7%, respectively, at 4 years. Graft function was similar between ABOi (creatinine, 140.3 μmol/L) and ABOc recipients (creatinine, 140.2 μmol/L) (P = 0.99), with no significant change over the study period in either group (Δcreatinine, -0.83 vs 6.6 μmol/L) (P = 0.59). There was no transplant glomerulopathy in biopsies from either group. Interstitial fibrosis (IF) and tubular atrophy (TA) was present in 7 (28%) of 25 ABOi compared with 7 (20.6%) of 34 ABOc (P = 0.52). Progression of IF/TA from implantation was noted in 6 (24%) of 25 ABOi and 6 (17.6%) of 34 ABOc, respectively. C4d staining without antibody-mediated rejection was present in 13 (52%) 25 early posttransplant biopsies from ABOi recipients by immunohistochemistry, but in only 4 (16%) of 25 at 12 months.
  
  
  
  ABO-incompatible renal transplant performed with antibody removal and conventional immunosuppression continues to provide excellent patient and graft survival, and stable renal function over 4 years. Coupled with absent transplant glomerulopathy and low rates of progressive IF/TA on earlier biopsies, this suggests that ABOi with conventional immunosuppression and antibody removal, without rituximab or splenectomy, can achieve long-term outcomes comparable to ABO-compatible transplantation.
authors: 1 Department of Nephrology, Royal Melbourne Hospital, Victoria, Australia. 2 Department of Medical Biology, University of Melbourne, Victoria, Australia. 3 Division of Immunology, Walter and Eliza Hall Institute of Medical Research, Victoria, Australia. 4 Department Anatomical Pathology, Royal Melbourne Hospital, Victoria, Australia. 5 Department of Medicine, University of Melbourne, Victoria, Australia 6 Department of Nephrology, Western Hospital, Victoria, Australia.
authors: Kevin V
authors: KV
authors: Chow
authors: Shaun M
authors: SM
authors: Flint
authors: Angeline
authors: A
authors: Shen
authors: Anthony
authors: A
authors: Landgren
authors: Moira
authors: M
authors: Finlay
authors: Anand
authors: A
authors: Murugasu
authors: Rosemary
authors: R
authors: Masterson
authors: Peter
authors: P
authors: Hughes
authors: Solomon J
authors: SJ
authors: Cohney
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001706:Biopsy; D001787:Blood Group Incompatibility / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D000069283:Rituximab / Q000627:therapeutic use; D013156:Splenectomy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D000069283:Rituximab