Overview

Since serious shortfalls in organ donation remain the biggest barrier to increasing the number of transplantations, ABO-incompatible living kidney transplantation (ABOi-KT) is one of the effective options for expanding the donor pool. ABOi-KT is generally recognized to be difficult and expensive transplantation, and many transplant physicians are reluctant to perform ABOi-KT and prefer to do kidney donor exchange transplantation. However, current desensitization protocol of ABOi-KT has been simplified and much less heavy compared to early experiences over the last decade. We are accepting up to 64x (sometime 256x) of ABO titer at transplant surgery and as a result, 60% of cases have 0 or one plasma pheresis (PP) prior to ABOi-KT. Our current desensitization protocol for ABOi-KT includes 0-2 times of PP and low dose rituximab (200mg/person) injection without intravenous immunoglobulin (IVIg). Post-transplant immunosuppression includes basiliximab induction and low-dose tacrolimus, low-dose MMF, and steroids. We do not employ thymoglobulin induction, IVIg, nor prophylactic posttransplant PP. 
Currently, 10-year patient and graft survival of ABOi-KT is about 90% and 85%, respectively with minimal complication. In this seminar, I would like to share our current desensitization and immunosuppression protocol and outcome of ABOi-KT.