Japanese experience of ABO-incompatible living kidney transplantation

Since 1989, when we performed the first ABO-incompatible living-related kidney transplantation (ABO-ILKT) in Japan, many Japanese institutions have started their own ABO-ILKT programs. By the end of 2005, 851 ABO-ILKTs had been performed in Japan at 82 institutions. In the present study, we review the surveillance data of the Japanese ABO-Incompatible Transplantation Committee and our own, recent experience of ABO-ILKT. One-, 3-, 5-, and 10-year patient survival has been 95%, 92%, 90%, and 85%, respectively, whereas 1-, 3-, 5-, and 10-year graft survival has been 89%, 85%, 79%, and 61%, respectively. Between 1989 and 1999, a triplicate immunosuppressive regimen consisting of tacrolimus or cyclosporine A plus azathioprine or mizoribine plus methylprednisolone was administered at most institutions. Between 2000 and 2004, tacrolimus, mycophenolate mofetil, and methylprednisolone were used at most of the institutions. Splenectomy was performed in most recipients between 1989 and 2004. Recently, many institutions started to use anti-CD20 antibody (rituximab) as an alternative to splenectomy. In most cases, ABO-ILKT recipients underwent 3 or 4 sessions of plasmapheresis or double-filtration plasmapheresis before transplantation. A greater incidence of acute rejection was observed during the cyclosporine A era, but the incidence of rejection was markedly reduced in the tacrolimus era. Anti-CD20 antibody induction markedly reduced the incidence of antibody-mediated rejection and greatly improved the results. In conclusion, there were significant differences in graft survival and the incidence of rejection before and after the introduction of tacrolimus/mycophenolate mofetil. In addition, rituximab as an alternative to splenectomy is definitely an effective regimen for successful ABO-ILKT.