Current Progress in ABO incompatible kidney transplantation

Publication date: Available online 20 August 2015 Source:Kidney Research and Clinical Practice Author(s): Tai Yeon Koo, Jaeseok Yang ABO incompatible kidney transplantation (ABOi KT) was introduced to expand the donor pool and minimize shortages of kidneys for transplantation. Because improved outcomes of ABOi KT were reported in Japan in the early 2000’s, the number of ABOi KTs has been increasing world-wide. In addition, a better understanding of immune pathogenesis and subsequent aggressive immunosuppression has helped to make effective desensitization protocols. Current strategies of ABOi KT consist of pre-transplant antibody removal using plasmapheresis or immunoadsorption to prevent hyperacute rejection, and potent maintenance immunosuppression, such as tacrolimus and mycophenolate mofetil, to inhibit antibody-mediated rejection. Recent outcomes of ABOi KT are comparable to ABO compatible KT. However, there are still many problems to be resolved. Very high anti-ABO antibody-producers are difficult to desensitize. In addition, ABOi KT is associated with an increased risk of infection and possibly malignancy due to aggressive immunosuppression. Optimization of desensitization and patient-tailored immunosuppression protocols are needed to achieve better outcomes of ABOi KT. This review provides an overview of the history, immune mechanism, immunosuppressive protocol, outcomes, current obstacles, and future perspectives in ABOi KT.
Source: Kidney Research and Clinical Practice - Category: Urology & Nephrology Source Type: research