Current protocols and outcomes of ABO-incompatible kidney transplantation

Table 1 Meta-analysis of 4810 ABO incompatibility kidney transplants: Clinical characteristics and outcomes of recipients[40]

Total number of living ABOi kidney transplants, n = 4810
Outcome	Case report and series, n = 54	Cohort studies, n = 25	Case controls, n = 2	Registry studies, n = 2
N° patients	849	1874	103	1984
Follow-up, mean ± SD	21.3 ± 25.2	43.7 ± 22.6	66 ± 26	---
Patient survival, %	98.1	93	97.8	88.3
Graft survival, %	93.2	84.4	72	71.5
Acute rejection, n (%)	153 (18)	462 (52.3)	26 (2.9)	237 (26.8)
Peak baseline ab titer	1:128 (1:32-1:256)	1:64 (1:8-1:1024)	1:128 (1:32-1:512)	---
Pre-transplant ab titer	1:4 (1:2-1:8)	1:16 (1:1-1:32)	1:16 (1:2-1:32)	---

ABOi: ABO incompatibility.

Table 2 Meta-analysis of 4810 ABO incompatibility kidney transplants, grade evidence profile of studies for patient and graft survival after preconditioning therapies[40]

	Risk of bias/quality of evidence	Consistency	Directness	Precision	Publication bias	Overall survival probability	Quality of evidence
Apheresis: 21 (12 cohort studies; 1 case-control; 8 case series)	No serious risk of bias; lack RCTs	Some inconsistency	Direct	No serious imprecision	Suspected publication bias	Patient survival 93.5%	Very low
Immunoadsorption: 4 (3 cohort studies; 1 case series)	No serious risk of bias; Lack of RCTs	No inconsistency	-1	No serious imprecision	No important publication bias	Patient survival 96.4%	Very low
Splenectomy: 12 (9 cohort studies; 3 case series)	No serious risk of bias; Lack of RCTs	Some inconsistency	Direct	No serious imprecision	Suspected publication bias	Patient survival 91%	Very low
Rituximab: 17 (11 cohort studies; 6 case series)	No serious risk of bias; Lack of RCTs	No inconsistency	Direct	No serious imprecision	Suspected publication bias	Patient survival 96.2%	Very low

RCT: Randomized controlled trial.

Table 3 Main controversies encountered in ABO incompatibility renal transplantation

Main controversies
Apheresis technique used
Role of rituximab
Utility and role of IVIG
Method to detect isoagglutinins quantity
Type of immunosuppression
Utility of posttransplantation apheresis
Accommodation
Role of protocol biopsies
Principal complications

IVIG: Intravenous immunoglobulin.