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2015 ; 34
(3
): 170-9
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Current progress in ABO-incompatible kidney transplantation
#MMPMID26484043
Koo TY
; Yang J
Kidney Res Clin Pract
2015[Sep]; 34
(3
): 170-9
PMID26484043
show ga
ABO-incompatible kidney transplantation (ABOi KT) was introduced to expand the
donor pool and minimize shortage of kidneys for transplantation. Because improved
outcomes of ABOi KT were reported in Japan in the early 2000s, the number of ABOi
KTs has been increasing worldwide. 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
pretransplant 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 with 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.