pISSN 3022-6783
eISSN 3022-7712

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J Korean Soc Transplant 2014; 28(1): 5-12

Published online March 31, 2014

https://doi.org/10.4285/jkstn.2014.28.1.5

© The Korean Society for Transplantation

Current Issues in ABO-Incompatible Kidney Transplantation

Yaeni Kim, M.D., Byung Ha Chung, M.D. and Chul Woo Yang, M.D., Ph.D.

Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea

Correspondence to: 양철우, 서울시 서초구 반포대로 222 가톨릭대학교 서울성모병원 신장내과, 장기이식센터, 137-701
Tel: 02-2258-6037, Fax: 02-535-0323
E-mail: yangch@catholic.ac.kr

Received: March 7, 2014; Revised: March 10, 2014; Accepted: March 10, 2014

Abstract

Organ shortage is a critical issue in Korea as well as in other countries. In Korea, in 2013, the number of end-stage renal disease patients on the waiting list was 14,600; however, only 1,759 patients received transplantation during 2013. Recent advances in immunosuppression and antibody removal protocols have made ABO-incompatible kidney transplantation (ABO IKT) feasible, and have increased the opportunities for patients to undergo transplantation, especially for patients who do not have an ABO-compatible donor. The first ABO IKT was reported in 1955, but was unsuccessful due to the absence of an effective preparation protocol for antibody removal. In the 1980s, Alexandre used a protocol for removal of anti-ABO antibodies for the first time; however, the outcome was still inferior to that of ABO-compatible KT. Since 2000, with the advancement of immunosuppression and plasmapheresis, the outcome of ABO IKT has shown significant improvement and is now comparable to that of ABO-compatible KT. However, there are still several undetermined issues in ABO IKT. For example, issues regarding anti-ABO antibody titer, pretransplant desensitization method, immune suppressant regimen, and the role of C4d have still not been established. In this article, we reviewed the current status and protocol of ABO IKT and addressed to the undetermined issues in this field.

Keywords: ABO blood-group system, Antibodies, Kidney transplantation, Plasmapheresis, Rituximab