ABO-Incompatible Living Kidney Transplants: Evolution of Outcomes and Immunosupp

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/ajt.13502/abstract

ABO-Incompatible Living Kidney Transplants: Evolution of Outcomes and Immunosuppressive Management
M. Okumi, D. Toki, T. Nozaki, T. Shimizu, H. Shirakawa, K. Omoto, M. Inui, H. Ishida andK. Tanabe*
[size=78%]DOI: 10.1111/ajt.13502[/size]
American Journal of Transplantation
Early View (Online Version of Record published before inclusion in an issue)

Abstract
ABO-incompatible living kidney transplantation (ABO-ILKT) has steadily become more widespread. However, the optimal immunosuppressive regimen for ABO-ILKT remains uncertain. We aimed to determine the longitudinal changes in the outcomes from ABO-ILKT compared with those from ABO-compatible living kidney transplantation (ABO-CLKT) over the last 25 years. Of 1195 patients who underwent living kidney transplantations (LKT) at our institute between 1989 and 2013, 1032—including 247 ABO-ILKT and 785 ABO-CLKT cases—were evaluated for graft survival, patient survival, infectious adverse events, and renal function. The patients were divided into four groups according to the transplantation era and ABO-compatibility. In the past decade, ABO-ILKT and ABO-CLKT recipients yielded almost equivalent outcomes with respect to the 9-year graft survival rates, which were 86.9% and 92.0%, respectively (hazard ratio
1.38, 95% confidence interval [CI] 0.59–3.22, p = 0.455). The graft survival rate for ABO-ILKT conducted between 2005 and 2013 was better than that for ABO-ILKT conducted between 1998 and 2004 (HR 0.30, 95% CI 0.13–0.72, p = 0.007). ABO-ILKT recipients showed substantial improvements in the graft survival rate over time. Graft survival was almost identical over the past decade, regardless of ABO-incompatibility. Currently, ABO-ILKT is an acceptable treatment for patients with end-stage renal disease.[/font]