De novo m TOR inhibitor‐based immunosuppression in ABO ‐incompatible kidney transplantation

ABO ‐incompatible ( ABO i ) kidney transplantation ( KT x) has become an accepted therapeutic option in renal replacement therapy for patients without a blood group‐compatible living donor. Using different desensitization strategies, most centers apply B‐cell depletion with rituximab and maintenance immunosuppression ( IS ) with tacrolimus and mycophenolic acid. This high load of total IS leads to an increased rate of surgical complications and virus infections in ABO i patients. Our aim was to establish ABO i KT x using an immunosuppressive regimen, which is effective in preventing acute rejection without increasing the risk for viral infections. Therefore, we selected a de novo immunosuppressive protocol with low‐dose calcineurin inhibitor and the mTOR inhibitor everolimus for our ABO i program. Here, we report the first 25 patients with a complete three‐yr follow‐up treated with this regimen. Three‐yr patient survival and graft survival were 96% and 83%. The rate of acute T‐cell‐mediated rejections was low (12%). Cytomegalovirus ( CMV ) infection was evident in one patient only (4%). Surgical complications were common (40%), but mild in 80% of cases. We demonstrate that ABO i KT x with a de novo m TOR inhibitor‐based regimen is feasible without severe surgical or immunological complications and a low rate of viral infections.