SP774OUTCOME OF PEDIATRIC ABO-INCOMPATIBLE LIVING KIDNEY TRANSPLANTATION BETWEEN 2002 AND 2014: AN ANALYSIS OF THE JAPANESE KIDNEY TRANSPLANT REGISTRY

Abstract

INTRODUCTION AND AIMS: ABO-incompatible living kidney transplantation (ABOi-LKT) has been performed to enlarge the organ donor pool in the late 1980s. Over the last 25 years, new immunosuppressive agents including mycophenolate mofetil (MMF) and basiliximab have been introduced in the early 2000s. Notably, in 2003, as an alternative to splenectomy (SP), B cell depletion therapy using rituximab was applied for ABOi-recipents. Although extensive data has been accumulated in adult population, available data is very limited in pediatric ABOi-LKT. Therefore, we analyzed data from the Japanese Kidney Transplant Registry (JKTR) to examine the outcomes of pediatric ABOi-LKT between 2002 and 2014. METHOD(S): This study used data from JKTR. The JKTR includes data on all donor and transplant recipients in Japan, submitted by the members of JST and JSCRT. The present work was approved by the Tokyo Women's Medical University's Ethics Committee. A total of 126 pediatric patients (< 20 years old) who underwent ABOi- LKT between 2002 and 2014 were identified. There were compared with matched controls that underwent ABO-compatible LKT (ABOc-LKT). All recipients received a basiliximab induction therapy and a triple immunosuppressive protocol comprising calcineurin inhibitors, MMF, and corticosteroid. To remove anti-blood type antibodies, ABOi-recipients received plasmapheresis before transplantation. In ABOi-recipients, SP was performed at the time of transplantation until the middle to the late 2000s, and thereafter rituximab was administered before transplantation, as an alternative to SP. Subgroup analyses among ABOi-LKT were also performed according to with or without SP. Patient survival and graft survival curves were estimated using the Kaplan- Meier method, and differences between the curves were assessed using log-rank tests. RESULT(S): Estimated patient survival was similar among ABOi recipients (98.0%, 98.0%, 98.0%, and 98.0% at 1, 3, 5, and 10 years) compared with ABOc-matched controls (99.3%, 99.0%, 99.0%, and 98.5%; p=0.5). Among ABOi recipients, no difference between recipients with SP vs. recipients without SP was observed (p=0.8). There were no predominant causes of death in both ABOi- and ABOc-recipients. Estimated graft survival was similar among ABOi recipients (94.9%, 92.3%, 90.5%, and 85.2% at 1, 3, 5, and 10 years) compared with ABOc-matched controls (97.5%, 95.3%, 92.2%, and 84.8%; p=0.9). Among ABOi recipients, no difference between recipients with SP vs. recipients without SP was detected (p=0.4). No particular causes of graft loss predominantly affected ABOi- or ABOc-recipients. CONCLUSION(S): The results of this registry analysis suggest that ABOi-LKT can be efficiently performed with modern protocols, even in pediatric recipients. ABOi-LKT is now one of the options available to those caring for children with end-stage renal disease.