EXCELLENT MID-TERM RESULTS OF ABO-INCOMPATIBLE LIVING KIDNEY TRANSPLANTATION UNDER PRETRANSPLANT ONE-WEEK IMMUNOSUPPRESSION WITH TACROLIMUS, MYCOPHENOLATE MOFETIL, AND STEROID

Abstract

O75 Aims: The supply of cadaveric and living kidneys is not sufficient to satisfy the increasing number of patients requiring renal transplantation. Expansion of the donor pool by overcoming ABO-incompatibility would help to solve this problem. Since 2001, we have been employing one-week pretransplant immunosuppression with tacrolimus (FK) / mycophenolate mofetil (MMF) /methylprednisolone (MP) and have obtained excellent short-term results without any serious complications. Mid-term results of ABO-incompatible renal transplantation under one-week pretransplant immunosuppression with low-dose FK/MMF/MP maintenance immunosuppression are reviewed. Methods: Thirty-two adult patients underwent ABO-incompatible LKT at our institute between January 2001 and September 2003. There were 16 males and 16 females, with a mean age of 33 years. Plasmapheresis was carried out to remove anti-AB antibodies prior to the kidney transplantation. Since January 2001, we administered FK (0.1 mg/kg/d) / MMF (1-2 g/d) / MP (125 mg/d) concomitantly with plasmapheresis starting from 7 days before transplantation. Splenectomy was done at the time of kidney transplantation in all patients. In the maintenance phase (6 months after transplantation), all patients were maintained on low-dose immunosuppression with FK/MMF/MP. The average dose of FK, MMF, and MP was 0.05mg/kg, 1000mg/day, and 5mg/day, respectively. The target trough level of FK was 5ng/ml in the maintenance phase. Results: Patient and graft survival was 100% and 95% at three years, respectively. Only one graft was lost due to humoral rejection during the observation time. The incidence of acute rejection was 25%. Also, the incidence of steroid-resistant acute rejection was 7%. There was no serious infectious complication during the observation period. Protocol biopsies did not show any late-onset rejection. Conclusions: Mid-term results of ABO-incompatible renal transplantation under one-week pretransplant immunosuppression with low-dose FK/MMF/MP maintenance immunosuppression showed excellent patient and graft outcome.