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J Transplant. 2014;2014:913902. doi: 10.1155/2014/913902. Epub 2014 Feb 6.

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

Author information

1
Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus Medical Center, D414, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
2
Department of Hematology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
3
Department of Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.

Abstract

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 Steroids could be withdrawn safely 3 months after transplantation.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.

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