The Experience of ABO Incompatible Kidney Transplantation in Japanese Single Center

Abstract

In Japan, because of lack of deceased kidney donors, living donor kidney transplantation is mainly performed and some quantity of ABO incompatible transplantation is included. ABO incompatible kidney transplantation demonstrate an upward trend and account for about 40% of living donor kidney transplantation in our center today. (Figure 1) 78 cases of ABO incompatible kidney transplantation have been performed in our center so far, and recent results are good. So we report our experience of ABO incompatible kidney transplantation.[Figure 1]Though initial ABO incompatible kidney transplantation in our center was performed on October 9th, 1990, we stopped this program February, 1996 by reason of poor results. 5 years and 8 months later, we restarted ABO incompatible kidney transplantation program with new immunosuppressive regimen using mycophenolate mofetil (MMF). New immunosuppressive regimen lead to a better results, but at that time, we resected recipient's spleen for suppressing the immune reaction by B cells. 4 years later, we started to use rituximab instead of splenectomy. Our recent immunosuppressive regimen contains calcineurin inhibitor (tacrolims or cyclosporin), antimetabolite (MMF or mizoribine (Mz)), prednisolone, rituximab, and basiliximab. Additionally, several time of plasma exchange (PE) or double filtration plasmapheresis (DFPP) is performed preoperatively for removal of blood group antibody and anticoagulant therapy with nafamostat mesilate and administration of fresh frozen plasma (FFP) of blood group AB will be performed after transplantation. Though results in the early period was not good, recent results are very good and comparable to ABO compatible cases. (Figure 2) But long-term graft survivals are inapparent, so more cases and research are needed.[Figure 2]