The First Fifty ABO Blood Group Incompatible Kidney Transplantations: The Rotterdam Experience

Abstract EN

This study describes the single center experience and long-term results of ABOi kidney transplantation using a pretransplantation protocol involving immunoadsorption combined with rituximab, intravenous immunoglobulins, and triple immune suppression.

Fifty patients received an ABOi kidney transplant in the period from 2006 to 2012 with a follow-up of at least one year.

Eleven antibody mediated rejections were noted of which 5 were mixed antibody and cellular mediated rejections.

Nine cellular mediated rejections were recorded.

Two grafts were lost due to rejection in the first year.

One-year graft survival of the ABOi grafts was comparable to 100 matched ABO compatible renal grafts, 96% versus 99%.

At 5-year follow-up, the graft survival was 90% in the ABOi versus 97% in the control group.

Posttransplantation immunoadsorption was not an essential part of the protocol and no association was found between antibody titers and subsequent graft rejection.

Steroids could be withdrawn safely 3 months after transplantation.

Adverse events specifically related to the ABOi protocol were not observed.

The currently used ABOi protocol shows good short and midterm results despite a high rate of antibody mediated rejections in the first years after the start of the program.