In an effort to overcome the severe organ shortage, ABO-incompatible kidney transplantation has
been carried out in many transplant centers worldwide over the last decade. In the 1980s, ABOincompatible
kidney transplantation was electively performed in Europe and Japan and the early results
were acceptable though short-term results were significantly poorer than those of ABO-compatible kidney
transplantation (80% vs. 95% at one year, 79% vs. 92% at three years in ABO-incompatible vs. ABOcompatible
transplantations, respectively). The original preconditioning regimens included splenectomy,
plasmapheresis, and immunosuppression with ciclosporin, azathioprine and steroids.
Early in this century, many potent immunosuppressive agents, such as tacrolimus, mycophenolate mofetil,
rituximab, basiliximab, thymoglobulin and daclizimab were introduced in the field of clinical kidney
transplantation. With these potent immunosuppressive agents, the outcomes of ABO-incompatible kidney
transplantation improved significantly. Currently, in most transplant programs, preconditioning and
immunosuppressive regimens typically include a rituximab injection, plasmapheresis or immunoadsorption
and immunosuppression with tacrolimus, mycophenolate mofetil and steroids. The latter is a mild regimen
comparable to those for ABO-compatible kidney transplantation. Recently, one year graft survival in most
ABO-incompatible programs has exceeded 90-95%. Furthermore, the incidence of rejection is less than
10% in most reports of ABO-incompatible kidney transplantation.
ABO-incompatible kidney transplantation has become a safe, excellent treatment option for renal
failure patients.
Keywords: ABO Incompatible Kidney Transplantation, Rituximab, Plasmapheresis, C4d, Acute Rejection,
Living Donor, Organ Shortage, Desensitization.
