Clinical Outcomes between Living Related and Living Unrelated Kidney Transplantation in ABO-Incompatible Kidney Transplant Recipients
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Background/Aims: Kidney transplantation (KT) is the best treatment for end-stage renal disease patients.Although previous studies have demonstrated that the clinical outcome following living related (LR) KT is better than that following unrelated (LUR) KT in ABO-compatible KT recipients, recent studies showed no differences in clinical outcomes between the two treatments.In this study, we compared the clinical outcomes of LR and LUR KT in ABO-incompatible KT recipients.Methods: From January 2011 to August 2013, 19 cases of ABO-incompatible KT were analyzed retrospectively.Eight kidneys (7 cases of parent-offspring and 1 case of siblings, Group 1) were donated from living-related donors and 11 (all spousal donors, Group 2) from living-unrelated donors.We investigated patient survival, graft survival, acute rejection, graft function, and complications.Results: On Kaplan-Meier analysis, patient and graft survival during follow-up were 87.5% and 87.5% in Group 1; both were 100% in Group 2. Acute rejection, graft function, and medical and surgical complications were not significantly different between the two groups.Conclusions: The short-term clinical outcomes between LR and LUR KT in ABO-incompatible KT recipients were equivalent.Most domestic cases of LUR KT are from spousal donors and the spousal donor will be a major donor in ABO-incompatible KT patients.(Keywords:
ABO incompatibility
ABO incompatibility
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ABO incompatibility
Corneal Transplant
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Economic shortage
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Economic shortage
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Objective:To investigate ABO blood type in kidney transplantation cases.Methods:The survey was on the 143 cases with kidney transplantation.Results:The difference of ABO blood type between the kidney transplantation cases and normal group is no significant.The blood type of the cases one by one in order are O(40.5%),A(32.9%),B(18.9),AB(7.7%).In the 143 cases,B(18.9%)is lower the normal group(22.9%),O(40.5%)is higher the normal group(34.8%),the difference is no significant.Conclusion:ABO blood type is no obvious effect on kidney transplantation cases.
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Acute liver failure is associated with a high mortality rate due to multi-organ failure, sepsis and cerebral edema. Liver transplantation remains the only life saving treatment available for these critically ill patients. Urgent liver transplantation within 48 to 72 hours has shown to be crucial for reducing the waiting list mortality of these patients. However, liver grafts are a scarce resource, leading to a significant rate of mortality for patients in need of urgent liver transplant. ABO-incompatible (ABO-in) liver transplantation is occasionally used as a rescue alternative when an ABO-identical (ABO-id) or compatible (ABO-c) graft is not available. The outcomes of ABO-in liver transplantation using deceased donors have been variable but mostly reported to be associated with poor graft function, early graft loss and an increased rate of complications. There are however limited studies examining long term outcomes of liver transplantation with ABO-in grafts. The aim of the study was to compare long term mortality and graft survival of patients undergoing liver transplantation with ABO-id vs. ABO-c and ABO-in donor grafts. A secondary objective was to determine other predictors of poor outcome in patients requiring urgent liver transplantation for acute liver failure. A retrospective cohort study was done to examine adult patients who underwent urgent liver transplantation between 1985 and 2016 in London, Ontario. Patients were divided into three cohorts depending on their grafts’ ABO compatibility: ABO-id, ABO-c and ABO-in. Transplant outcomes in the peri and post transplant period were collected for all three cohorts. Multivariate logistic regression was used to assess ABO-compatibility as a predictor of graft failure and patients’ death. 73 patients with emergency liver transplantation were studied. Of those, 9.6% received an ABO-in graft. Rate of retransplantation in ABO-id, ABO-c and ABO-in groups was 2.5%, 11.5% and 57%, respectively. The OR of graft failure in the ABO-in group was 13 times greater when compared to ABO-id (OR 13.3, p 0.02). There was no statistically significant difference in graft survival between ABO-c and ABO-id groups (OR 3.5, p 0.12). OR of death was not significantly different between the three groups. Age (OR 1.06, p0.04), need for inotropic support (OR 6.2, p0.02) and stroke (OR 15.2, p0.03) were more important predictors of death than ABO compatibility itself. ABO-in liver transplantation was associated with higher rates of graft failure and retransplantation however there was no significant difference in long term mortality in these patients. In select adult patients with acute liver failure in need of an emergency liver transplantation, ABO-in transplants should be viewed as an important lifesaving therapeutic option with comparable results in long term survival. None
ABO incompatibility
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Previously, ABO-incompatible kidney transplantation (KTx) was believed to be a "taboo" for immunological reasons.In Japan, the Tokyo Women's Medical University reported the first successful case of such transplantation, performed on January 19, 1989.Since then, we have been striving to improve the outcome of ABO-incompatible transplantation for a quarter of a century.At Niigata University, ABO-incompatible KTx was performed in April 1996, with 80 patients being operated by 2013.The graft survival rates for those patients were 92.5%, 92.5%, 68.6%, and 61.0% for the 1st, 5th, 10th, and 15th years after transplantation, respectively.In September 2004, we were the first medical institution in Japan to introduce desensitization therapy into our clinical practice, which involved the use of rituximab and did not include splenectomy.The graft survival rate dramatically improved after 2004: 96.7% at 1 year, 96.7% at 5 years, and 87.9% at 10 years after transplantation, respectively.Our department initiated translational research on structural analysis and immune response of ABO histo-blood group carbohydrate antigens.Based on our experimental and clinical results, desensitization therapy before transplantation was more effective to inhibit B-cell immunity than multiple antibody removal.
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When a renal transplant candidate's only medically-acceptable living kidney donor is ABO incompatible, the most common practice is to place them on the deceased donor list. Over the past few years, the implementation of paired kidney donor exchange programs and the development of protocols to overcome the ABO blood group barrier have become much more successful and widespread. Here we review the therapeutic options for patients whose only living kidney donor is ABO incompatible, with a specific emphasis on the rationale for and the current outcomes of ABO incompatible living donor kidney transplantation.
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