ABO-Incompatible Living Kidney Transplants: Evolution of Outcomes and Immunosuppressive Management

Okumi, Masayoshi; Toki, Daisuke; Nozaki, Taiji; Shimizu, Tomokazu; Shirakawa, Hiroki; Omoto, Kazuya; Inui, Masashi; Ishida, Hideyuki; Tanabe, Kazunari

doi:10.1111/ajt.13502

Cited by 90 publications

(71 citation statements)

References 34 publications

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“…As a result, it has become an acceptable treatment option in Japan, accounting for more than 30% of all living donor kidney transplantation. Excellent outcomes have been achieved, and the rates of graft survival in these patients are presently similar to those in recipients of ABO-compatible grafts [3][4][5][6][7]. Although our previous report demonstrated that this procedure may become a viable treatment option for elderly patients with ESKD [8], there have been few reports on elderly ABO-incompatible kidney transplantation.…”

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confidence: 78%

Favorable Outcomes of Elderly ABO-Incompatible Kidney Transplantation-Pilot Single Center Experience

et al. 2018

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Background: The growth in the end-stage kidney disease (ESKD) population has been predominantly in the older adult population. In Japan, ABO-incompatible kidney transplantation has become an acceptable treatment option. However, few studies have been conducted on elderly ABO-incompatible kidney transplantation. Patients and Methods: Seventeen patients aged 60 years and older who received their grafts from ABO-incompatible living donors at our institution between December 2006 and September 2016 were enrolled in this study, and the outcome of these recipients was evaluated. Results: All 17 patients underwent successful kidney transplantation. Both overall patient and graft survival rates were 100, 100, and 83.3% at posttransplant 1, 3, and 5 years respectively. Six of the 17 patients (35.3%) had an episode of biopsy-proven acute cellular rejection. Two patients who developed steroid- and deoxyspergualin-resistant acute rejection required anti-human thymocyte immunoglobulin. Conclusion: ABO-incompatible kidney transplantation may be an effective radical renal replacement therapy for elderly patients with ESKD, although it could be a high-risk procedure.

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confidence: 78%

Favorable Outcomes of Elderly ABO-Incompatible Kidney Transplantation-Pilot Single Center Experience

et al. 2018

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“…Because a large end-stage kidney disease population and severe organ shortage have resulted in waiting times for deceased donor kidney transplantation close to 15 years in Japan, ABO-incompatible kidney transplantation has become a reasonable alternative for end-stage kidney disease patients with an ABO-incompatible living donor, the outcomes of which have nearly equaled those of ABO-compatible kidney transplantation [4,5] . Moreover, our recent report showed that ABO-incompatible kidney transplantation may be an effective treatment for patients even at a low-volume institution where only about 2 kidney transplants a month are performed on average [14] .…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Moreover, our recent report showed that ABO-incompatible kidney transplantation may be an effective treatment for patients even at a low-volume institution where only about 2 kidney transplants a month are performed on average [14] . ABO-incompatible kidney transplantation is an established renal replacement therapy for end-stage kidney disease [5,14] , and patients receiving living donor grafts have longer patient and graft survival rates than those receiving deceased donor grafts [15] . ABO-incompatible kidney transplantation may therefore be an alternative treatment as a second transplant.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Excellent outcomes have been achieved, and recently, there have been no significant differences in transplant outcomes between ABO-incompatible and ABO-compatible kidney transplantation [4,5] . Although this procedure may become an acceptable option for second kidney transplantation, there have been no reports regarding ABO-incompatible kidney transplantation as a second transplant.…”

Section: Introductionmentioning

confidence: 99%

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Pilot Experience with ABO-Incompatible Kidney Transplantation as a Second Transplant

et al. 2019

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Background: Despite advances in immunosuppressant medications, improvement in long-term survival for kidney transplant recipients has been more difficult to achieve. In fact, the number of patients with failing grafts who must either return to dialysis or undergo a second transplant is increasing. Second transplantation is associated with reduced mortality rates compared to remaining on dialysis after an initial graft loss. Nowadays, excellent ABO-incompatible kidney transplant outcomes have been achieved. However, there have been no reports on ABO-incompatible kidney transplantation as a second transplant. Patients and Methods: Three patients who received their graft from an ABO-incompatible living donor at our institution as a second transplant were enrolled in this study. We focused on immunosuppressive therapy for second ABO-incompatible kidney transplantation, donor-specific antibody status before the second transplant, patient and graft survivals, and complications. Results: All 3 patients successfully underwent ABO-incompatible kidney transplantation as a second transplant with a follow-up period of 141, 39, and 24 months. Patient and graft survival rates were 100%. Conclusions: ABO-incompatible kidney transplantation may be an acceptable treatment for patients who need a second renal replacement therapy after their initial graft failure.

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“…On the other hand, the availability of living donor transplants, and markedly improved patient survival of allogeneic kidney at 3 years (66, 67). Thus, stronger justification besides organ shortage may be needed for implementation of xenogenic transplantation.…”

Section: The Potential Benefit Of a Tolerance Strategy For Isletmentioning

confidence: 99%

Tolerance in xenotransplantation

Yamada

Sykes²,

Sachs³

2017

Current Opinion in Organ Transplantation

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This review describes recent progress in tolerance-inducing strategies across xenogeneic immunological barriers as well as the potential benefit of a tolerance strategy for islets and kidney xenotransplantation. Recent findings Using advanced gene editing technologies, xenotransplantation from multi-transgenic alpha-1,3-galactosyltransferase knockout pigs has demonstrated marked prolongation of renal xenograft survival, ranging from days to greater than several months for life-supporting kidneys, and >2 years in a heterotopic non-life-supporting cardiac xenograft model. Continuous administration of multiple immunosuppressive drugs has been required and attempts to taper immunosuppression have been unsuccessful. It appears likely that low levels of T cell-dependent antibodies and activation of innate responses are responsible for xenograft loss. Mixed chimerism and thymic transplantation approaches have achieved xenogeneic tolerance in pig-to-mouse models and both have recently been extended to pig-to-baboon models. Encouraging results have been reported, including persistence of macrochimerism, prolonged pig skin graft survival, donor-specific unresponsiveness in vitro and detection of recent T cell emigrants in vivo. Summary Although tolerance induction in vivo has not yet been achieved in pig-to-baboon models, recent results are encouraging that this goal will be attainable through genetic engineering of porcine donors.

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ABO-Incompatible Living Kidney Transplants: Evolution of Outcomes and Immunosuppressive Management

Cited by 90 publications

References 34 publications

Favorable Outcomes of Elderly ABO-Incompatible Kidney Transplantation-Pilot Single Center Experience

Favorable Outcomes of Elderly ABO-Incompatible Kidney Transplantation-Pilot Single Center Experience

Pilot Experience with ABO-Incompatible Kidney Transplantation as a Second Transplant

Tolerance in xenotransplantation

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