ABO-incompatible kidney transplantation as a renal replacement therapy-A single low-volume center experience in Japan

PLoS One. 2018 Dec 31;13(12):e0208638. doi: 10.1371/journal.pone.0208638. eCollection 2018.


Introduction: Living donor kidney transplantation is preferable to deceased donor transplantation due to its superior long-term patient and graft survivals. However, ABO blood group incompatibility is a major barrier to living donor kidney transplantation. ABO-incompatible kidney transplantation has been performed in Japan since the late 1980's, but it is still globally uncommon. The objective of this study is to compare the clinical outcomes of ABO-incompatible kidney transplantation (ABO-IKT) with that of ABO-compatible kidney transplantation (ABO-CKT) at an institution where only about two kidney transplants are performed a month on average.

Design: A single center propensity score-matched cohort study.

Patients and methods: We retrospectively collected and analyzed the data of 240 patients with end-stage kidney disease (ESKD) who underwent living donor kidney transplantation at Osaka City University Hospital from January 1999 to December 2016, of which 66 patients were ABO-IKT. The remaining 174 patients who underwent ABO-CKT were studied as the control group, and the clinical outcomes of ABO-IKT and ABO-CKT recipients were compared based on propensity score matching.

Results: After propensity score matching, there were no significant differences in both patient survival and death-censored graft survival rates between the ABO-IKT and ABO-CKT groups. Moreover, there were no significant differences in estimated glomerular filtration rate as well as frequency of acute cellular rejection, antibody-mediated rejection, infectious adverse events, malignancies, and post-operative bleeding between the two groups.

Conclusion: Currently, ABO-IKT may be an acceptable treatment for patients with ESKD even at a low-volume transplant center.

MeSH terms

  • ABO Blood-Group System / immunology*
  • Adult
  • Blood Group Incompatibility*
  • Cohort Studies
  • Female
  • Glomerular Filtration Rate
  • Graft Rejection / prevention & control
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Japan
  • Kidney / pathology
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / pathology
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Propensity Score
  • Proportional Hazards Models
  • Renal Replacement Therapy
  • Retrospective Studies
  • Survival Rate


  • ABO Blood-Group System
  • Immunosuppressive Agents

Grants and funding

The author(s) received no specific funding for this work.