Review
Copyright ©2014 Baishideng Publishing Group Co.
World J Transplant. Mar 24, 2014; 4(1): 18-29
Published online Mar 24, 2014. doi: 10.5500/wjt.v4.i1.18
Table 1 Combination of blood type and compatibility
Donor
ABOAB
RecipientA-+-+
B+--+
O++-+
AB----
Table 2 Historical clinical reports in ABO incompatible kidney transplantation
Ref.Type of studyStudy populationABOi populationDesensitizationOutcome
Hume et al[18]Observational91No treatmentGraft nephrectomy day 17
Starzl et al[19]Observational32SPx (1 case)Graft survival 74 d (1 case), patient death day 24 (1 case)
Sheil et al[20]Observational22No treatmentGraft nephrectomy day 14
Alexandre et al[11]Observational2323PE/SPx2-yr graft survival: 88% (related donor), 50% (unrelated donor)
Ota et al[21]Observational, comparative5151DFPP and/or IAs/SPx2-yr graft survival: 87% vs 84.6% vs 50% ( A- vs B- vs ABO-incompatible)
Tanabe et al[22]Observational, comparative43367DFPP and IAs/SPx8-yr graft survival: 73% vs 80 % (ABOi vs ABOc)
Ishida et al[23]Observational9393DFPP/SPx5-yr graft survival: 73%
Ohta et al[24]Observational, pediatric1010DFPP or PE or IAs/SPx5.4-yr graft survival: 100%
Shishido et al[25]Observational, pediatric1616PE and IAs/SPx5-yr graft survival: 85%
Takahashi et al[2]Observational, comparative1496441DFPP or PE or IAs/SPx9-yr graft survival: 59% vs 57% (ABOi vs ABOc)
Shimmura et al[26]Observational, comparative167167DFPP and/or IAs/SPx5-yr graft survival: 74.3% vs 78.5% ( CYA with AZ or MZ vs TAC or MMF)
Futagawa et al[27]Observational, comparative37803191NA5-yr graft survival: 66.2% vs 79.5% (ABOi vs ABOc)
Ishida et al[28]Observational, comparative222222DFPP/SPx5-yr graft survival: 73% vs 90% ( CYA with AZ vs TAC with MMF)
Tyden et al[29]Observational, comparative33460IAs/RIT/IVIGGraft survival: ABOi 97% (1.5-yr) vs ABOc 95% (1.8-yr)
Galliford et al[30]Observational1010PE/RIT/IVIG1-yr graft survival: 100%
Genberg et al[31]Observational, comparative4515IAs/RIT/IVIGGraft survival: ABOi 86.7% (3.4-yr) vs ABOc 86.7% (4.0-yr)
Oettl et al[32]Observational1010IAs/RIT/IVIG1.3-yr graft survival: 100%
Toki et al[33]Observational, comparative5757DFPP/SPx8-yr graft survival: 49% vs 95% (AAMR vs non-AAMR)
Wilpert et al[34]Observational, comparative8340IAs/RIT/IVIGGraft survival: ABOi 100% (3.3-yr) vs ABOc 93% (1.5-yr)
Tyden et al[1]Observational, comparative, pediatric3810IAs/RIT/IVIGGraft loss within 3 years: ABOi 1 case, ABOc 2 cases
Flint et al[35]Observational, comparative8937PE/IVIG1-yr graft survival: 100% (ABOi vs ABOc)
Fichinoue et al[36]Observational, comparative393113DFPP or PE/SPx or RIT5-yr graft survival: 88.4% vs 90.3% vs 100% (ABOc vs ABOi-SPx vs ABOi-RIT)
Habicht et al[37]Observational, comparative6821IAs/RIT/IVIG1-yr graft survival : 100% (ABOi vs ABOc)
Lipshutz et al[38]Observational1818PE/RIT/IVIG1-yr graft survival: 94.4%
Shirakawa et al[39]Observational, comparative7474DFPP/RIT1-yr graft survival: 95.7% vs 98.% ( RIT 500mg vs RIT 200 mg)
Shishido et al[3]Observational, comparative, pediatric32352PE/SPx or RIT15-yr graft survival: 86% vs 78% (ABOi vs ABOc)
Montgomery et al[4]Observational, comparative78193738NA10-yr cumulative incidence of graft loss: 27.1% vs 23.9% (ABOi vs ABOc)
Morath et al[40]Observational, comparative1919IAs or IAns/RIT/IVIG1-yr graft survival: 100% (IAs vs IAns)
Uchida et al[41]Observational2525DFPP or PE/SPx or RIT4.5-yr graft survival: 100%
Ashimine et al[42]Observational, comparative32092DFPP/SPx or RIT or none5-yr graft survival: 87% vs 97.7% (ABOi vs ABOc)
Table 3 Current protocols for ABO incompatible kidney transplantation
AuthorCountry,yearRituximab dosePretransplant ISAntibody depletionIVIGTarget titer at the time of transplantationInduction ISMaintenance ISPosttransplant antibody depletion
Adult recipients
Rituximab protocol
Saito et al[53]Japan,2006375 mg/m2 (twice) at -14 and -1 dMMF/MP at -1 moDFPP or PE-< 1:16BAS (20 mg at 0and 4 d)CYA/MMF/MP-
Tyden et al[54]Sweden, 2006375 mg/m2 (once) at -1 moTAC/ MMF/Pred at -13 dIAs0.5 g/kg after last IAs< 1:8-TAC/MMF/PredIAs, 3 times
Chikaraishi et al[55]Japan,2008100 mg/m2 (twice) at -8 and -1 dMMF/MP at -14 d, TAC at -3 dDFPP and PE-< 1:8BAS (20 mg at 0and 4 d)TAC/MMF/MP-
Galliford et al[30]United Kingdom, 20081000 mg (twice) at first day of PE and at the operative dayTAC/MMF at -14 dPE0.1 g/kg after each PE< 1:4DAC (2 mg/kg at 0 and 14 d)TAC/MMF/PredPE at 1 and 3 d
Genberg et al[31]Sweden, 2008375 mg/m2 (once) at -1 moTAC/MMF/Pred at -10 dIAs0.5 g/kg at -1 d< 1:8-TAC/MMF/PredIAs, 3 times
Oettl et al[32]Switzerland, 2009375 mg/m2 (once) at -1 moTAC/MMF /Pred at -14 dIAs0.5 g/kg after lastIAs< 1:8BAS (20 mg at 0and 4 d)TAC/MMF/PredIAs or PE (not routinely)
Sivakumaran et al[78]United States, 2009375 mg/m2 (once) at -3 wkMMF at -1 moPE2 g/kg after last PENAALE (1 mg/kg at 0 and 14 d)TAC/MMF/Pred-
Wilpert et al[34]Germany, 2010375 mg/m2 (once) at -1 moTAC/MMF or MPS/Pred at -7 dIAs0.5 g/kgat -1 to-5 d< 1:4BAS (20 mg at 0and 4 d)TAC/MMF/PredIAs (not routinely)
Fuchinoue et al[36]Japan,2011100-1000 mg, 1-3 timesCYA or TAC/MMF at -2 dDFPP or PE-< 1:16BAS (20 mg at 0and 4 d)CYA or TAC/MMF/steroid-
Habicht et al[37]Germany, 2011375 mg/m2 (once) at -1 moTAC/MMF/Pred at -1 moIAs30 g at -1to -2 d< 1:8-TAC/MMF/MPIAs (not routinely)
Lipshutz et al[38]United States, 2011375 mg/m2 (once) at -1 moTAC/MMF at the first day of PEPE10 g after each PE< 1:8ATG (1.5 mg/kgfor 4 d)TAC/MMF/PredPE (not routinely)
Shirakawa et al[39]Japan, 2011500 or 200 mg/m2 (once), at -5 to -7 dTAC/MMF/MP at -7 dDFPP-< 1:32BAS (20 mg at 0and 4 d)TAC/MMF/MP-
Morath et al[40]Germany, 2012375 mg/m2 (once) at -1 moTAC/MMF/MP at the first day of IAsIAs0.5 g/kg after lastIAs< 1:16BAS (20 mg at 0and 4 d)TAC/MMF/MPIAs or PE (not routinely)
Uchida et al[41]Japan,2012150 mg/m2 (twice) at -14 and 0 dMMF/MP at -1 Mo, CYA or TAC at -3 dDFPP or PE-< 1:16BAS (20 mg at 0and 4 d)CYA or TAC/MMF/MP-
Rituximab-free protocol
Montgomery et al[43]United States,2009-TAC/MMF at the first day of PEPE0.1 g/kg after each PE< 1:16DAC (2 mg/kg initial dose, 1 mg/kg every 2 wk for total 5 doses)TAC/MMF/PredPE, at least twice (with IVIG 0.1 g/kg)
Flint et al[35]Australia, 2011-MMF at -10 to -14 dPE0.1 g/kg after each PE< 1:8BAS (20 mg at 0 and 4 d)TAC/MMF/PredPE (not routinely)
Ashimine et al[42]Japan,2013-MMF at -14 dDFPP-< 1:8BAS (20 mg at 0 and 4 d)CYA or TAC/MMF/Pred-
Pediatric recipients
Genberg et al[31]Sweden, 2008375 mg/m2 (once) at -1 moTAC/MMF/Pred at -10 dIAs0.5 g/kg at -1 d< 1:8-TAC/MMF/PredIAs, 3 times
Tyden et al[1]Sweden, 2011[1]375 mg/m2 (once) at -1 moTAC/MMF/Pred at -13 dIAs0.5 g/kg after lastIAs< 1:8-TAC/MMF/ PredIAs, 3 times
Table 4 Pro and cons for ABO incompatible kidney transplantation
Pro ABOi-KT
Reducing waiting list and time
Expanding living donor pool
Improvement of patient's prognosis
Excellent graft survival (comparable with ABOc-KT)
Contra ABOi-KT
Comparative high immunological risk
Higher incidence of acute AMR
Intensified immunosuppression
Antibody depletion therapy
Increasing expenditure
Higher incidence of viral infection