ABO-Incompatible Kidney Transplantation : The Surprising Absence of Hyperacute Rejection

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Owing to the shortage of deceased donors in Japan, since 1989, we have performed ABO-incompatible kidney transplantation（ABO-IKTx） to expand the indication for living donor kidney transplantation. During the past 2 decades, about 2,000 ABO-IKTxs were performed. Since 2001 the success rate for these kidney transplants has reached 96% for 1-year graft survival and 91% for 5-year graft survival, similar to outcomes of ABO-compatible kidney transplantation （ABO-CKTx）. This dramatic improvement in results means that ABO-IKTx has become accepted as a therapeutic alternative for end-stage renal failure. Today ABO-IKTx accounts for 30% of all living donor kidney transplantations performed in Japan. 　 In 1901 Karl Landsteiner discovered the presence of human ABO blood groups, and for many years ABO-IKTx was considered contraindicated, as the medical community assumed that this procedure would result in immediate/hyperacute ABO-related rejection followed by graft loss. 　When we actually attempted the procedure, however, we found that acute antibody-mediated rejection（ AMR）developed, but not a single instance of ABO-related hyperacute rejection. This phenomenon can be demonstrated epidemiologically. Yet, that does not answer the fundamental question of "Why is hyperacute rejection absent?" This article addresses potential mechanisms of acute AMR across ABO mismatched barriers as well as summarizing graft/patient survival of ABO-IKTxs in Japan.

弘前医学. 64(Suppl.), 2013, p.S28-S44

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  • 弘前医学

    弘前医学 64 (Supplement), S28-S44, 2013-04-02

    弘前大学大学院医学研究科・弘前医学会

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