Three-Year Outcomes Following 1420 ABO-Incompatible Living-Donor Kidney Transplants Performed After ABO Antibody Reduction

Opelz, Gerhard; Morath, Christian; Süsal, Caner; Tran, Thuong Hien; Zeier, Martin; Döhler, Bernd

doi:10.1097/tp.0000000000000312

Cited by 145 publications

(150 citation statements)

References 16 publications

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“…No antibody-mediated rejection occurred during our follow-up period, and the rate of acute cellular rejection was 14.3% (2/14) in this study. A previous large-sized, multicenter study revealed that the frequency of rejection treatment was 16.3% in ABO-incompatible kidney transplantation [27], which was similar to our rate of acute cellular rejection.…”

Section: Discussionsupporting

confidence: 68%

“…Meanwhile, previous reports have shown that the administration of rituximab induces proinflammatory cytokines releases associated with regulatory B cell depletion. However, in ABO-incompatible kidney transplantation, any cytokine release would have been resolved by plasmapheresis and administration of steroid before transplantation [27]. Previously, we showed that acute cellular rejection in ABO-incompatible kidney transplant recipients receiving rituximab might be associated with late-onset neutropenia due to B cell-related cytokine release [16, 17].…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcomes of ABO-Incompatible Kidney Transplantation in Patients with End-Stage Kidney Disease due to Diabetes Nephropathy

et al. 2019

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Background: Diabetes nephropathy is one of the most common causes of end-stage kidney disease (ESKD) worldwide. The data are clear that kidney transplantation is superior to remaining on dialysis for patients with diabetes. However, there have been no reports on ABO-incompatible kidney transplantation in patients with ESKD due to diabetes nephropathy. Patients and Methods: We conducted a retrospective, observational study to investigate the clinical outcomes of ABO-incompatible kidney transplantation for patients with pre-existing diabetes nephropathy at our institution from April 2011 to October 2017. A total of 14 recipients were enrolled in this study. Results: All 14 patients underwent successful kidney transplantation. Both overall patient and graft survival rates were 100, 89.9, and 89.9% at 1, 3, and 5 years, respectively. One patient died 20 months after transplantation with a functioning graft due to pancreas cancer. Two of the 14 patients (14.3%) developed biopsy-proven acute cellular rejection during the follow-up period. The median observation period was 32.0 months (range 5–83 months). Conclusion: ABO-incompatible kidney transplantation may be an acceptable renal replacement therapy for ESKD patients with diabetes.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of ABO-Incompatible Kidney Transplantation in Patients with End-Stage Kidney Disease due to Diabetes Nephropathy

et al. 2019

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“…However, ABO-incompatible (ABOi) renal transplantation has become more popular and hundreds of patients have been successfully transplanted across the ABO-barrier [32][33][34]. Infants have low levels of ABO-antibodies and are immunologically good candidates for ABOi-transplantation.…”

Section: Donor Characteristicsmentioning

confidence: 99%

Renal transplantation in infants

2015

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Renal transplantation (RTx) has become an accepted mode of therapy in infants with severe renal failure. The major indications are structural abnormalities of the urinary tract, congenital nephrotic syndrome, polycystic diseases, and neonatal kidney injury. Assessment of these infants needs expertise and time as well as active treatment before RTx to ensure optimal growth and development, and to avoid complications that could lead to permanent neurological defects. RTx can be performed already in infants weighing around 5 kg, but most operations occur in infants with a weight of 10 kg or more. Perioperative management focuses on adequate perfusion of the allograft and avoidance of thrombotic and other surgical complications. Important long-term issues include rejections, infections, graft function, growth, bone health, metabolic problems, neurocognitive development, adherence to medication, pubertal maturation, and quality of life. The overall outcome of infant RTx has dramatically improved, with long-term patient and graft survivals of over 90 and 80 %, respectively.

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“…As shown in Table 5, ABOi patients had lower levels of Hb and platelets in the early post-KT period (P = 0.02, P = 0.0001, respectively), but there was no statistical difference by the end of the 24-month follow-up: i.e., 13.8 for ABOi ± 1.7 versus 13 ± 1.7 g/ dL for the ABOc group for Hb, and 202.7 ± 46.4 for ABOi versus 204.6 ± 67.7×10 3 /mm 3 for the ABOc group for platelets. Amongst all peripheral lymphocytes, there were lower proportions of lymphocyte CD19 in the early post-KT period in ABOi recipients (1.5±2.1 in the ABOi group vs. 14.3±19.5% in the ABOc group, P=0.002); these results correspond to use of rituximab in ABOi recipients.…”

Section: Hematological Characteristics Throughout the 24-month Followmentioning

confidence: 99%

“…However, the lack of deceased donors and the increasing numbers of patients with ESRD and on a KT waiting-list has caused long waiting times for a suitable allograft (3). For this reason a living-donor KT becomes an important option (4).…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes after ABO-incompatible kidney transplantation; a single-center French study

Abdulrahman¹,

Naciri²,

Allal³

et al. 2017

J Nephropathol

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Background: ABO-incompatible (ABOi) is as efficient as ABO-compatible (ABOc) kidneytransplantation in the setting of live-donation. Objectives: To evaluate the long-term outcomes (i.e. >6 months) of 44 consecutive ABOi living-donor kidney-transplants (KTx). The results were compared to those from 44 ABOc KTx that were matched with ABOi-patients on age, gender, and date of transplantation. Patients and Methods: With regards to immunosuppression (IS) only ABOi-patients received pre-transplant IS, that included rituximab. Induction therapy relied significantly more frequently on basiliximab in ABOc-than in ABOi-patients 77.2% vs. 38.6% (P = 0.0002). Post-transplant IS relied only on tacrolimus/mycophenolic acid and steroids in ABOipatients, whereas some ABOc-patients were alternatively on cyclosporine (13.6%)/ everolimus (11.3%) and no steroids (7%), respectively (P = 0.05). Results: In ABOi-patients there was no isoagglutinin titer rebound posttransplant. At last follow-up patient and graft survival was similar in the two groups, as well as kidneyallograft function. Acute rejection rates (cellular, humoral, or mixed) were similar across both groups (ABOi: 22.7%; ABOc: 20.4%). With regards to bacterial and viral infections the only significant difference between the two groups was that at month three there were significantly more BKV viruria in ABOi (25%) vs. 6.8% in ABOc (P = 0.03). De novo donor-specific alloantibody were detected in 13.6% ABOi and 4.5% ABOc patients (ns). Readmission rates in our department for less than two days were more frequent for ABOi conversely readmission rates for more than two days was similar across the groups. Conclusions: ABOi-kidney transplantation after desensitization provides in the long-term same results as those observed in live-donor ABOc-kidney transplantation.

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Three-Year Outcomes Following 1420 ABO-Incompatible Living-Donor Kidney Transplants Performed After ABO Antibody Reduction

Abstract: In this analysis of prospectively collected data from a large series of ABO-incompatible living-donor kidney transplants performed at 101 centers, death-censored graft and patient survival rates were similar to those achieved in ABO-compatible control groups over the same period.

Cited by 145 publications

References 16 publications

Clinical Outcomes of ABO-Incompatible Kidney Transplantation in Patients with End-Stage Kidney Disease due to Diabetes Nephropathy

Clinical Outcomes of ABO-Incompatible Kidney Transplantation in Patients with End-Stage Kidney Disease due to Diabetes Nephropathy

Renal transplantation in infants

Long-term outcomes after ABO-incompatible kidney transplantation; a single-center French study

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