ABO-Incompatible Living Kidney Transplants: Evolution of Outcomes and Immunosuppressive Management

Am J Transplant. 2016 Mar;16(3):886-96. doi: 10.1111/ajt.13502. Epub 2015 Nov 10.


ABO-incompatible living kidney transplantation (ABO-ILKT) has steadily become more widespread. However, the optimal immunosuppressive regimen for ABO-ILKT remains uncertain. We aimed to determine the longitudinal changes in the outcomes from ABO-ILKT compared with those from ABO-compatible living kidney transplantation (ABO-CLKT) over the last 25 years. Of 1195 patients who underwent living kidney transplantations (LKT) at our institute between 1989 and 2013, 1032-including 247 ABO-ILKT and 785 ABO-CLKT cases-were evaluated for graft survival, patient survival, infectious adverse events, and renal function. The patients were divided into four groups according to the transplantation era and ABO-compatibility. In the past decade, ABO-ILKT and ABO-CLKT recipients yielded almost equivalent outcomes with respect to the 9-year graft survival rates, which were 86.9% and 92.0%, respectively (hazard ratio [HR] 1.38, 95% confidence interval [CI] 0.59-3.22, p = 0.455). The graft survival rate for ABO-ILKT conducted between 2005 and 2013 was better than that for ABO-ILKT conducted between 1998 and 2004 (HR 0.30, 95% CI 0.13-0.72, p = 0.007). ABO-ILKT recipients showed substantial improvements in the graft survival rate over time. Graft survival was almost identical over the past decade, regardless of ABO-incompatibility. Currently, ABO-ILKT is an acceptable treatment for patients with end-stage renal disease.

Keywords: ABO incompatibility; clinical research; practice; desensitization; dysfunction; immunosuppressive regimens; induction; kidney (allograft) function; kidney transplantation; nephrology.

MeSH terms

  • ABO Blood-Group System / immunology*
  • Adult
  • Blood Group Incompatibility / immunology*
  • Desensitization, Immunologic / methods*
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Graft Survival
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kidney Failure, Chronic / surgery*
  • Kidney Function Tests
  • Kidney Transplantation*
  • Living Donors
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors


  • ABO Blood-Group System
  • Immunosuppressive Agents