ABO-Incompatible Kidney Transplantation
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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.Cite
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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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Although uremic osteoporosis is a component of mineral and bone disorder in chronic kidney disease, uremic toxin (UT) concentrations in patients with end-stage kidney disease and bone mineral density (BMD) changes after kidney transplantation have not previously been described. We hypothesized that elevated UT concentrations at the time of transplantation could have a negative impact on bone during the early post-transplantation period. Hence, we sought to determine whether concentrations of UTs (trimethylamine-N-oxide, indoxylsulfate, p-cresylsulfate, p-cresylglucuronide, indole-3-acetic acid, hippuric acid, and 3-carboxy-4-methyl-5-propyl-furanpropionic acid) upon transplantation are predictive markers for (i) osteoporosis one month after transplantation, and (ii) a BMD decrease and the occurrence of fractures 12 and 24 months after kidney transplantation. Between 2012 and 2018, 310 kidney transplant recipients were included, and dual-energy X-ray absorptiometry was performed 1, 12, and 24 months after transplantation. The UT concentrations upon transplantation were determined by reverse-phase high-performance liquid chromatography. Indoxylsulfate concentrations upon transplantation were positively correlated with BMD one month after transplantation for the femoral neck but were not associated with osteoporosis status upon transplantation. Concentrations of the other UTs upon transplantation were not associated with osteoporosis or BMD one month after transplantation. None of the UT concentrations were associated with BMD changes and the occurrence of osteoporotic fractures 12 and 24 months after transplantation. Hence, UT concentrations at the time of kidney transplantation were not predictive markers of osteoporosis or fractures.
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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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The aim of this study was to characterize patient antibodies before and after cadaver and/or living-donor kidney transplantation and to correlate these data with the clinical course after transplantation.Sera from 69 cadaver, 9 living-related and 2 patients waiting for living-donor kidney transplantation were analyzed by the complement dependent cytotoxicity (CDC) test, flow cytometry (FCXM) and ELISA.FCXM revealed that 15.0% of patients before transplantation and 16.7% after transplantation had antibodies to donor cells. 10.3% patients were positive before and after transplantation (+/+), while 6.8% developed antibodies early after transplantation (-/+). Analysis of the specificity of those antibodies by ELISA showed that it was directed to: 1) mismatched donor HLA antigens 2) antigens belonging to the same cross-reacting group (CREG) as the mismatched donor antigens 3) HLA antigens not expressed by donor cells or, probably, to non-HLA antigens.Anti-HLA antibodies were detected in patients before and after transplantation and in most cases their anti-HLA specificity could be determined. Fast and precise characterization of antibodies in patients before and after transplantation can be performed by both sensitive methods--FCXM and ELISA--which may help predict the onset of immunological complications and, consequently, improve the prognosis after organ transplantation.
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Abstract Introduction Electrocardiographic (ECG) changes before and after kidney transplantation are not well‐defined. Our aim was to describe the evolution of ECG in patients on dialysis before and after successful kidney transplantation and to explore the association between ECG findings and major cardiovascular (CV) events and mortality after kidney transplantation. Patients and methods Electrocardiographics were collected retrospectively 3 times: at entry to the transplantation waiting list, at transplantation, and 1 year after the transplantation from 212 kidney transplantation recipients. Altogether 19 ECG variables were analyzed. Results Left ventricular hypertrophy was present in 10.2% by the Cornell voltage‐duration product criteria and 10.7% by the Sokolow‐Lyon voltage criteria before kidney transplantation. The presence of ST depression (OR 3.12, 95% CI 1.12 −8.7 and P = .03) at entry to the waiting list and Q wave at the time of transplantation (OR 3.28, 95% CI 1.06‐10.10 and P = .04) were both independently associated with major CV events after the transplantation. In addition, the presence of Q wave at entry to the waiting list was a risk factor of premature death after the transplantation (OR 2.92, 95% CI 1.06‐8.05 and P = .04). Discussion Careful analysis of the ECG before transplantation can be used to estimate cardiovascular events and mortality risk after kidney transplantation.
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Nephrology
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