Excellent Long-Term Outcome of ABO-Incompatible Living Donor Kidney Transplantation; a Single Center Experience for Over 20 Years

Abstract

Background: Although kidney transplantation is the most reassuring treatment for patients with end-stage renal disease (ESRD), shortage of organ donation in Japan is crucial. This issue has forced widening of indications for kidney transplantation. Therefore, ABO-incompatible living kidney transplantation (ABO-ILKT) has been a popular alternative to deceased kidney transplantation. In this retrospective single center study, we analyzed the long-term graft survival of ABO-incompatible living donor kidney transplant for over 20 years by comparing with ABO-compatible living kidney transplantation (ABO-CLKT) as control. Methods: In all, 1020 patients with ESRD underwent living donor kidney transplantation at our institute between 1989 and 2011. 238 cases were ABO-ILKT and 782 cases were ABO-CLKT. The mean age of ABO-ILKT group was 42.1 years (range 17 to 75), with 146 males and 92 females. Plasmapheresis and immunoadsorption were carried out to remove the anti-AB antibodies before the kidney transplantation. In the induction phase, most of the recipients received CNI (tacrolimus or cyclosporine)-based immunosuppression including methylprednisolone and mycophenolate mofetil. After 2002, all patients received basiliximab perioperatively. Between 1986 and 2004, splenectomy was performed at the time of ABO-ILKT. Thereafter, alternative to splenectomy, rituxamab was administered prior to ABO-ILKT. Log-rank testing was performed to determine differences in survival data. Results: Patient survival of ABO-ILKT at 1, 5, 10, 15, and 20 years post-transplant were 97.8, 97.2, 92.0, 87.4, and 87.4%, respectively. Graft survival of ABO-ILKT at 1, 5, 10, 15, and 20 years post-transplant were 90.4, 86.9, 69.6, 55.6, and 48.4%, respectively. Whereas, Graft survival of ABO-CLKT at 1, 5, 10, 15, and 20 years post-transplant were 97.4, 88.2, 75.5, 64.7, and 58.1%, respectively. Patient survival had no significant difference from that of ABO-CLKT (p=0.741). Although graft survival of ABO-ILKT at 20 years post-transplant had approximately 10% reduction from that of ABO-CLKT, there was no statistical difference between ABO-ILKT and ABO-CLKT (p=0.08). Conclusion: Despite receiving intensified desensitization protocol compared to ABO-CLKT, ABO-ILKT is a acceptable treatment for patients with ESRD in terms of patient survival and graft survival.