Abstract
P336 Aims: ABO-incompatible living kidney transplantation has been performed to widen the indication and could help curtail the universal donor shortage. Between 1993 and Oct. 2003, we performed ABO-incompatible living kidney transplantation in 42 patients. The aim of this study is to estimate the risk of humoral immunity and how to prevent the graft loss of ABO-incompatible kidney transplantation. Methods: Our center performed 614 living-donor kidney transplantations. Forty –two patients received ABO-incompatible living-donor kidney transplants including 4 spousal and 38 living-related transplants. There were 23 male and 19 femails with mean age of 34 years.(11 - 57). To minimize risks, we conducted splenectomy at 2 weeks before the transplantation, eliminated anti-A and/or anti-B antibodies by double-filtration plasmapheresis (DFPP), and administered potent immunosuppressive agents, namely, cyclophosphamide, anti-lymphocyte globulin or anti-CD25 chimeric antibody, cyclosporine and prednisolone. Cyclosporine dosing was initiated at 12mg/kg/day and then was adjusted to achieve specified AUC0-4 target values. Results: The incidence of acute rejection during the first 3 months post transplantation was 33.3% (acute humoral; 6 cases, acute cellular; 5 cases, combined; 3 cases). Graft survival rate was 97.5% at 1 year and 96.5% at 5years, it was similar to that of the ABO-compatible living-related donor transplantation. In the spousal transplantations, all the grafts are functioning without any acute rejection. After the kidney transplantation, the anti-A/B IgM and IgG antibody levels were maintained at 37% and 46% of the pre-DFPP level, respectively. No antibody binding to the transplanted kidney was detected at any time (1 h to 2 yr) post transplantation. We believe that this good outcome is attributable to the thorough elimination of blood group antibodies by DFPP, splenectomy, and a strong inhibition of humoral immune reaction by cyclophosphamide. We consider spousal living donors an excellent source for ABO-incompatible living donor transplantation. Conclusion: 5-year graft survival has reached over 95%. ABO-incompatible kidney transplantation in our group provides an excellent outcome and is an acceptable treatment for end-stage of renal disease.
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