Background: The growth in the end-stage kidney disease (ESKD) population has been predominantly in the older adult population. In Japan, ABO-incompatible kidney transplantation has become an acceptable treatment option. However, few studies have been conducted on elderly ABO-incompatible kidney transplantation. Patients and Methods: Seventeen patients aged 60 years and older who received their grafts from ABO-incompatible living donors at our institution between December 2006 and September 2016 were enrolled in this study, and the outcome of these recipients was evaluated. Results: All 17 patients underwent successful kidney transplantation. Both overall patient and graft survival rates were 100, 100, and 83.3% at posttransplant 1, 3, and 5 years respectively. Six of the 17 patients (35.3%) had an episode of biopsy-proven acute cellular rejection. Two patients who developed steroid- and deoxyspergualin-resistant acute rejection required anti-human thymocyte immunoglobulin. Conclusion: ABO-incompatible kidney transplantation may be an effective radical renal replacement therapy for elderly patients with ESKD, although it could be a high-risk procedure.

Keywords:
Kidney transplantation, ABO-incompatible, Elderly
1.
Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK: Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999; 341: 1725–1730.
2.
Danovitch G, Savransky E: Challenges in the counseling and management of older kidney transplant candidates. Am J Kidney Dis 2006; 47:S86–S97.
3.
Takahashi K, Saito K, Takahara S, Okuyama A, Tanabe K, Toma H, Uchida K, Hasegawa A, Yoshimura N, Kamiryo Y; Japanese ABO-Incompatible Kidney Transplantation Committee: Excellent long-term outcome of ABO-incompatible living donor kidney transplantation in Japan. Am J Transplant 2004; 4: 1089–1096.
4.
Zschiedrich S, Kramer-Zucker A, Jänigen B, Seidl M, Emmerich F, Pisarski P, Huber TB: An update on ABO-incompatible kidney transplantation. Transpl Int 2015; 28: 387–397.
5.
Uchida J, Kuwabara N, Machida Y, Iwai T, Naganuma T, Kumada N, Nakatani T: Excellent outcomes of ABO-incompatible kidney transplantation: a single-center experience. Transplant Proc 2012; 44: 204–209.
6.
Uchida J, Machida Y, Iwai T, Kuwabara N, Iguchi T, Naganuma T, Kumada N, Kawashima H, Nakatani T: Clinical outcome of ABO-incompatible living unrelated donor kidney transplantation. Urol Int 2011; 86: 307–314.
7.
Okumi M, Toki D, Nozaki T, Shimizu T, Shirakawa H, Omoto K, Inui M, Ishida H, Tanabe K: ABO-incompatible living kidney transplants: evolution of outcomes and immunosuppressive management. Am J Transplant 2016; 16: 886–896.
8.
Uchida J, Iwai T, Machida Y, Kuwabara N, Kabei K, Murao M, Otoshi T, Naganuma T, Kumada N, Nakatani T: ABO-incompatible kidney transplantation in elderly patients over 60 years of age. Int Urol Nephrol 2012; 44: 1563–1570.
9.
Opelz G, Morath C, Süsal C, Tran TH, Zeier M, Döhler B: Three-year outcomes following 1420 ABO-incompatible living-donor kidney transplants performed after ABO antibody reduction: results from 101 centers. Transplantation 2015; 99: 400–404.
10.
Takahashi K, Saito K: ABO-incompatible kidney transplantation. Transplant Rev (Orlando) 2013; 27: 1–8.
11.
Uchida J, Iwai T, Kabei K, Nishide S, Yamasaki T, Kuwabara N, Naganuma T, Kumada N, Takemoto Y, Nakatanti T: ABO-incompatible living kidney transplant recipients from spousal donors receiving rituximab. Urol Int 2016; 97: 457–465.
12.
Uchida J, Machida Y, Iwai T, Naganuma T, Kitamoto K, Iguchi T, Maeda S, Kamada Y, Kuwabara N, Kim T, Nakatani T: Desensitization protocol in highly HLA-sensitized and ABO-incompatible high titer kidney transplantation. Transplant Proc 2010; 42: 3998–4002.
13.
Uchida J, Iwai T, Kato M, Machida Y, Naganuma T, Kumada N, Yoshimura R, Kawashima H, Kim T, Nakatani T: A novel approach to successful ABO-incompatible high-titer renal transplantation. Transplant Proc 2008; 40: 2285–2288.
14.
Kuypers DR: Immunotherapy in elderly transplant recipients: a guide to clinically significant drug interactions. Drugs Aging 2009; 26: 715–737.
15.
Martins PN, Pratschke J, Pascher A, Fritsche L, Frei U, Neuhaus P, Tullius SG: Age and immune response in organ transplantation. Transplantation 2005; 79: 127–132.
16.
Trouillhet I, Benito N, Cervera C, Rivas P, Cofán F, Almela M, Angeles Marcos M, Puig de la Bellacasa J, Pumarola T, Oppenheimer F, Moreno-Camacho A: Influence of age in renal transplant infections: cases and controls study. Transplantation 2005; 80: 989–992.
17.
Li P, Tian C, Ge N, Wang H, Liu L, Lou F, Björkholm M, Xu D: Premature senescence of T cells in long-term survivors of renal transplantation. Biochem Biophys Res Commun 2011; 407: 599–604.
18.
Heinbokel T, Hock K, Liu G, Edtinger K, Elkhal A, Tullius SG: Impact of immunosenescence on transplant outcome. Transpl Int 2013; 26: 242–253.
19.
Uchida J, Machida Y, Iwai T, Kuwabara N, Kabei K, Naganuma T, Kumada N, Kawashima H, Nakatani T: Conversion of stable ABO-incompatible kidney transplant recipients from mycophenolate mofetil with standard exposure calcineurin inhibitors (CNIs) to everolimus with very low exposure CNIs-a short-term pilot study. Clin Transplant 2014; 28: 80–87.
20.
Lim WH, Wong G, Pilmore HL, McDonald SP, Chadban SJ: Long-term outcomes of kidney transplantation in people with type 2 diabetes: a population cohort study. Lancet Diabetes Endocrinol 2017; 5: 26–33.
21.
Stel VS, van Dijk PC, van Manen JG, Dekker FW, Ansell D, Conte F, Kramar R, Leivestad T, Vela E, Briggs JD, Jager KJ: Prevalence of co-morbidity in different European RRT populations and its effect on access to renal transplantation. Nephrol Dial Transplant 2005; 20: 2803–2811.
22.
Baskin-Bey ES, Kremers W, Nyberg SL: A recipient risk score for deceased donor renal allocation. Am J Kidney Dis 2007; 49: 284–293.
23.
Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Gutierrez Robledo LM, Rockwood K, von Haehling S, Vandewoude MF, Walston J: Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14: 392–397.
24.
Anand S, Johansen KL, Kurella Tamura M: Aging and chronic kidney disease: the impact on physical function and cognition. J Gerontol A Biol Sci Med Sci 2014; 69: 315–322.
25.
McAdams-DeMarco MA, Ying H, Olorundare I, King EA, Haugen C, Buta B, Gross AL, Kalyani R, Desai NM, Dagher NN, Lonze BE, Montgomery RA, Bandeen-Roche K, Walston JD, Segev DL: Individual frailty components and mortality in kidney transplant recipients. Transplantation 2017; 101: 2126–2132.
26.
Pasina L, Brucato AL, Falcone C, Cucchi E, Bresciani A, Sottocorno M, Taddei GC, Casati M, Franchi C, Djade CD, Nobili A: Medication non-adherence among elderly patients newly discharged and receiving polypharmacy. Drugs Aging 2014; 31: 283–289.
27.
Claxton AJ, Cramer J, Pierce C: A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001; 23: 1296–1310.
28.
Chisholm-Burns MA, Kwong WJ, Mulloy LL, Spivey CA: Nonmodifiable characteristics associated with nonadherence to immunosuppressant therapy in renal transplant recipients. Am J Health Syst Pharm 2008; 65: 1242–1247.
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2018
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