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Journal of Transplantation
Volume 2014 (2014), Article ID 913902, 6 pages
Clinical Study

The First Fifty ABO Blood Group Incompatible Kidney Transplantations: The Rotterdam Experience

1Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus Medical Center, D414, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
2Department of Hematology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
3Department of Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

Received 24 November 2013; Revised 20 December 2013; Accepted 21 December 2013; Published 6 February 2014

Academic Editor: Kazuhiko Yamada

Copyright © 2014 Madelon van Agteren et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


This study describes the single center experience and long-term results of ABOi kidney transplantation using a pretransplantation protocol involving immunoadsorption combined with rituximab, intravenous immunoglobulins, and triple immune suppression. Fifty patients received an ABOi kidney transplant in the period from 2006 to 2012 with a follow-up of at least one year. Eleven antibody mediated rejections were noted of which 5 were mixed antibody and cellular mediated rejections. Nine cellular mediated rejections were recorded. Two grafts were lost due to rejection in the first year. One-year graft survival of the ABOi grafts was comparable to 100 matched ABO compatible renal grafts, 96% versus 99%. At 5-year follow-up, the graft survival was 90% in the ABOi versus 97% in the control group. Posttransplantation immunoadsorption was not an essential part of the protocol and no association was found between antibody titers and subsequent graft rejection. Steroids could be withdrawn safely 3 months after transplantation. Adverse events specifically related to the ABOi protocol were not observed. The currently used ABOi protocol shows good short and midterm results despite a high rate of antibody mediated rejections in the first years after the start of the program.