ABO-incompatible renal transplantation

The shortfall between organ donors and a growing population with end-stage kidney disease has resulted in increased transplant waiting times for patients, with increased mortality as a consequence. 1 Statistics and Clinical Studies, NHS Blood and TransplantAnnual report on kidney transplantation. Report for 2017/2018. https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/12256/nhsbt-kidney-transplantation-annual-report-2017-2018.pdfDate: 2018 Date accessed: March 23, 2019 Google Scholar Strategies to reduce this deficit include expanding the live donor pool by crossing the blood group barrier with ABO-incompatible live donor pairs. ABO-incompatible renal transplantation (ABOi-rTx) has been in practice worldwide for over three decades. Initially regarded as having similar outcomes to ABO-compatible renal transplantation (ABOc-rTx), 2 Takahashi K Saito K Takahara S et al. Excellent long-term outcome of ABO-incompatible living donor kidney transplantation in Japan. Am J Transplant. 2004; 4: 1089-1096 Crossref PubMed Scopus (292) Google Scholar more recent registry reports have suggested otherwise. 3 Montgomery JR Berger JC Warren DS James NT Montgomery RA Segev DL Outcomes of ABO-incompatible kidney transplantation in the United States. Transplantation. 2012; 93: 603-609 Crossref PubMed Scopus (195) Google Scholar Recipients require pre-operative desensitisation usually achieved with a combination of antibody removal and B-cell depleting therapies in conjunction with potent immunosuppression. This intense immunosuppression, although effective, remains a substantial concern as a cause of additional morbidity and mortality. Clinical outcomes after ABO-incompatible renal transplantation: a systematic review and meta-analysisDespite progress in desensitisation protocols and optimisation of ABOi-rTx procedures, excess mortality and loss of kidney grafts was found compared with ABOc-rTx within the first 3 years after transplantation. Only long-term outcomes after 5 years yielded equivalent survival rates and organ function. Awareness of the increased risks of infection, organ rejection, and bleeding could improve care of patients and promote efforts towards paired kidney exchange programmes. Full-Text PDF