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Current progress in ABO-incompatible kidney transplantation.

Koo TY, Yang J - Kidney Res Clin Pract (2015)

Bottom Line: Because improved outcomes of ABOi KT were reported in Japan in the early 2000s, the number of ABOi KTs has been increasing worldwide.Recent outcomes of ABOi KT are comparable with ABO-compatible KT.This review provides an overview of the history, immune mechanism, immunosuppressive protocol, outcomes, current obstacles, and future perspectives in ABOi KT.

View Article: PubMed Central - PubMed

Affiliation: Transplantation Center, Seoul National University Hospital, Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus

Desensitization protocols for ABOi KT.* This figure shows representative desensitization protocols for ABOi KT used at several transplant centers. Most centers have modified the original successful protocol. Desensitization protocols of Tokyo Women’s Medial University, Japan (A), Freiburg University Hospital, Germany (B), Stockholm group, Sweden (C), Johns Hopkins Hospital, USA (D), Mayo Clinic, USA (E), and Seoul National University Hospital, Korea (F), are shown. Details of the desensitization protocols of several centers can be found in the references [22,30,53,63–65].ABOi KT, ABO incompatible kidney transplantation; Anti-IL-2R, anti-interleukin-2 antibody; ATG, antithymocyte globulin; DFPP, double filtration plasmapheresis; IVIG, intravenous immunoglobulin; OP, transplantation operation; PP, plasmapheresis; RTX, rituximab.*These figures are based on published data of current protocols for an individual center. These protocols may have changed since publication.
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f0005: Desensitization protocols for ABOi KT.* This figure shows representative desensitization protocols for ABOi KT used at several transplant centers. Most centers have modified the original successful protocol. Desensitization protocols of Tokyo Women’s Medial University, Japan (A), Freiburg University Hospital, Germany (B), Stockholm group, Sweden (C), Johns Hopkins Hospital, USA (D), Mayo Clinic, USA (E), and Seoul National University Hospital, Korea (F), are shown. Details of the desensitization protocols of several centers can be found in the references [22,30,53,63–65].ABOi KT, ABO incompatible kidney transplantation; Anti-IL-2R, anti-interleukin-2 antibody; ATG, antithymocyte globulin; DFPP, double filtration plasmapheresis; IVIG, intravenous immunoglobulin; OP, transplantation operation; PP, plasmapheresis; RTX, rituximab.*These figures are based on published data of current protocols for an individual center. These protocols may have changed since publication.

Mentions: With increasing experience over the last decade, desensitization protocols were modified and continue to evolve (Fig. 1) [22,30,53,63–65]. However, the lack of controlled studies makes it difficult to compare various protocols and determine which is best.


Current progress in ABO-incompatible kidney transplantation.

Koo TY, Yang J - Kidney Res Clin Pract (2015)

Desensitization protocols for ABOi KT.* This figure shows representative desensitization protocols for ABOi KT used at several transplant centers. Most centers have modified the original successful protocol. Desensitization protocols of Tokyo Women’s Medial University, Japan (A), Freiburg University Hospital, Germany (B), Stockholm group, Sweden (C), Johns Hopkins Hospital, USA (D), Mayo Clinic, USA (E), and Seoul National University Hospital, Korea (F), are shown. Details of the desensitization protocols of several centers can be found in the references [22,30,53,63–65].ABOi KT, ABO incompatible kidney transplantation; Anti-IL-2R, anti-interleukin-2 antibody; ATG, antithymocyte globulin; DFPP, double filtration plasmapheresis; IVIG, intravenous immunoglobulin; OP, transplantation operation; PP, plasmapheresis; RTX, rituximab.*These figures are based on published data of current protocols for an individual center. These protocols may have changed since publication.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608875&req=5

f0005: Desensitization protocols for ABOi KT.* This figure shows representative desensitization protocols for ABOi KT used at several transplant centers. Most centers have modified the original successful protocol. Desensitization protocols of Tokyo Women’s Medial University, Japan (A), Freiburg University Hospital, Germany (B), Stockholm group, Sweden (C), Johns Hopkins Hospital, USA (D), Mayo Clinic, USA (E), and Seoul National University Hospital, Korea (F), are shown. Details of the desensitization protocols of several centers can be found in the references [22,30,53,63–65].ABOi KT, ABO incompatible kidney transplantation; Anti-IL-2R, anti-interleukin-2 antibody; ATG, antithymocyte globulin; DFPP, double filtration plasmapheresis; IVIG, intravenous immunoglobulin; OP, transplantation operation; PP, plasmapheresis; RTX, rituximab.*These figures are based on published data of current protocols for an individual center. These protocols may have changed since publication.
Mentions: With increasing experience over the last decade, desensitization protocols were modified and continue to evolve (Fig. 1) [22,30,53,63–65]. However, the lack of controlled studies makes it difficult to compare various protocols and determine which is best.

Bottom Line: Because improved outcomes of ABOi KT were reported in Japan in the early 2000s, the number of ABOi KTs has been increasing worldwide.Recent outcomes of ABOi KT are comparable with ABO-compatible KT.This review provides an overview of the history, immune mechanism, immunosuppressive protocol, outcomes, current obstacles, and future perspectives in ABOi KT.

View Article: PubMed Central - PubMed

Affiliation: Transplantation Center, Seoul National University Hospital, Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus