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Outcomes of Pediatric ABO-incompatible Living Kidney Transplantations From 2002 to 2015: An Analysis of the Japanese Kidney Transplant Registry

Hattori, Motoshi, MD, PhD1; Mieno, Makiko, PhD2; Shishido, Seiichiro, MD, PhD3,4; Aikawa, Atsushi, MD, PhD3; Ushigome, Hidetaka, MD, PhD5; Ohshima, Shinichi, MD, PhD6; Takahashi, Kota, MD, PhD7; Hasegawa, Akira, MD, PhD8 on behalf of the Japan Society for Transplantation and Japanese Society for Clinical Renal Transplantation

doi: 10.1097/TP.0000000000002259
Original Clinical Science—General

Background Extensive data have been accumulated for adults who have undergone ABO-incompatible (ABOi)-living kidney transplantation (LKT). In contrast, available published data on pediatric recipients who underwent ABOi-LKT from the early to middle 2000s is very limited. Thus, pediatric ABOi-LKT has remained relatively rare, and there is a lack of large, multicenter data.

Methods We analyzed data from the Japanese Kidney Transplant Registry to clarify the patient and graft outcomes of pediatric recipients who underwent ABOi-LKT from 2002 to 2015. A total of 102 ABOi and 788 ABO-compatible (ABOc) recipients were identified in this study. All recipients had received basiliximab and a triple immunosuppressive protocol comprising calcineurin inhibitors, mycophenolate mofetil, and steroids. The ABOi recipients also received preconditioning therapies including B-cell depletion by a splenectomy or rituximab treatment and therapeutic apheresis.

Results Death rates for ABOi and ABOc recipients were 0.17 versus 0.17 deaths per 100 patient-years. Graft loss rates for ABOi and ABOc recipients were 1.58 versus 1.45 events per 100 patient-years. No particular causes of death or graft loss predominantly affected ABOi or ABOc recipients.

Conclusions The results of this registry analysis suggest that pediatric ABOi-LKT can be performed efficiently. Although further studies are clearly required to perform pediatric ABOi-LKT more safely and less invasively, ABOi-LKT is now an acceptable treatment for pediatric patients with end-stage renal disease.

This Japanese Kidney Transplant Registry analysis shows no significant differences in patient or graft outcomes comparing ABO incompatible and compatible pediatric kidney transplant recipients.

1 Department of Pediatric Nephrology, Tokyo Women’s Medical University, School of Medicine, Tokyo, Japan.

2 Department of Medical Informatics Center for Information, Jichi Medical University, Tochigi, Japan.

3 Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan.

4 Department of Pediatric Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan.

5 Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.

6 National Center for Geriatrics and Gerontology, Aichi, Japan.

7 Niigata Organ Transplant Foundation, Niigata, Japan.

8 Kamata Minami-guchi Kidney Clinic, Tokyo, Japan.

Received 15 January 2018. Revision received 16 April 2018.

Accepted 17 April 2018.

The authors declare no funding or conflicts of interest.

M.H. participated in research design, the performance of the research, and the writing of the article. M.M. participated in research design, the performance of the research, and data analysis. S.S. participated in research design and the performance of the research. A.A., H.U., S.O., K.T., and A.H. participated in the performance of the research.

Correspondence: Motoshi Hattori, MD, PhD, Department of Pediatric Nephrology, Tokyo Women’s Medical University, School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. (hattori@twmu.ac.jp).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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