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ABO-incompatible kidney transplantation: long-term outcomes
Summary
ABO-incompatible kidney transplants (ABO-ILKT) in Japan show excellent long-term survival, comparable to ABO-compatible procedures. Advances like rituximab have made ABO-ILKT a safe and effective option for end-stage renal disease.
Area of Science:
- Nephrology
- Transplantation Immunology
Background:
- Over 2,000 ABO-incompatible living kidney transplantations (ABO-ILKT) performed in Japan over 20 years.
- ABO-ILKT significantly expands the donor pool, addressing organ shortages.
- ABO-ILKT is now a standard therapeutic option for end-stage renal failure.
Purpose of the Study:
- To evaluate the long-term outcomes of ABO-incompatible living kidney transplantation (ABO-ILKT).
- To compare the efficacy and safety of ABO-ILKT with ABO-compatible living kidney transplantation (ABO-CLKT).
- To highlight the evolution of desensitization protocols and their impact on ABO-ILKT.
Main Methods:
- Retrospective analysis of ABO-ILKT cases in Japan over 20 years.
- Comparison of graft survival rates between ABO-ILKT and ABO-CLKT.
- Description of evolving desensitization protocols, including the shift from splenectomy to rituximab.
Main Results:
- Excellent long-term outcomes (>20 years) for ABO-ILKT, comparable to ABO-CLKT.
- Significant improvement in 5- and 10-year graft survival rates (95% and 90%) in the last decade.
- Modern ABO-ILKT protocols involve minimal preconditioning (plasmapheresis, rituximab) and standard immunosuppression.
Conclusions:
- ABO-incompatible living kidney transplantation is a safe and highly effective standard option.
- Improved desensitization protocols have made ABO-ILKT less stressful and more accessible.
- Long-term graft survival for ABO-ILKT is excellent, rivaling ABO-CLKT outcomes.
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