Long-term Follow-up of ABO-Incompatible Kidney Transplantation in Freiburg, Germany: A Single-Center Outcome Report

Langhorst, Christina; Ganner, Athina; Schneider, Johanna; Prager, Eric Peter; Walz, Gerd; Pisarski, Przemyslaw; Jänigen, Bernd; Zschiedrich, Stefan

doi:10.1016/j.transproceed.2020.09.001

Cited by 6 publications

(6 citation statements)

References 23 publications

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“…First of all, we found excellent graft function in AB0i recipients at all considered intervals, from 1 month to 3 years after transplantation, comparable to AB0c controls. This finding is in line with what reported by other studies, including experiences from Heidelberg (9, 10), Freiburg (11) and the UK (12).…”

Section: Discussionsupporting

confidence: 94%

“…In a Johns Hopkins study on the risk of aAMR in AB0i transplantation (17), 26% of the 115 enrolled patients experienced aAMR, 49% within 30 days after transplantation. On the other hand, other single-center studies did not observe differences in the incidence of AR and aAMR between AB0i and AB0c LDKTs (9,11,12). These conflicting results can be explained considering different definitions of AR among studies, not all being biopsy-proven, and different cohorts, not comparable for baseline characteristics and used immunosuppressive therapy.…”

Section: Discussionmentioning

confidence: 87%

“…However, at 3 years there was no difference in survival between AB0i and AB0c LDKTs (21). Comparable longterm survival between AB0i and AB0c LDKTs was reported by the U.S. Scientific Registry (24) and by other single-center studies, as well (11,22). Available evidences, although not conclusive, seem to show a worse outcome during the first year after transplantation, while on the long-term patient survival becomes comparable in AB0i and AB0c recipients.…”

Section: Discussionmentioning

confidence: 88%

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Outcomes in AB0 Incompatible Living Donor Kidney Transplantation: A Case – Control Study

Cozzi

Donato²,

Ugolini³

et al. 2022

Front. Med.

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BackgroundPatients waiting for a kidney transplant by far exceed available organs. AB0 incompatible living donor kidney transplantation (AB0i LDKT) represents an additional therapeutic strategy, but with higher risk for complications. We aimed at evaluating outcomes of AB0i LDKTs compared to compatible (AB0c) controls at our Institution.MethodsRetrospective matched case – control study (1:2) comparing AB0i vs. AB0c LDKTs from March 2012 to September 2021. Considered outcomes: graft function, acute rejection, sepsis, CMV infection, BK virus reactivation, death-censored graft survival, patient survival.ResultsSeventeen AB0i LDKTs matched to 34 AB0c controls. We found excellent graft function, comparable in the two groups, at all considered intervals, with an eGFR (ml/min/1.73 m2) of 67 vs. 66 at 1 year (p = 0.41), 63 vs. 64 at 3 years (p = 0.53). AB0i recipients had a statistically significant higher incidence of acute rejection, acute antibody-mediated rejection and sepsis within 30 days (p = 0.016; p = 0.02; p = 0.001), 1 year (p = 0.012; p = 0.02; p = 0.0004) and 3 years (p = 0.004; p = 0.006; p = 0.012) after surgery. There was no difference in CMV infection, BK virus reactivation, death-censored graft survival between the two groups. Patient survival was inferior in AB0i group at 1 and 3 years (88.2 vs. 100%; log-rank p = 0.03) due to early death for opportunistic infections. AB0i LDKTs spent longer time on dialysis (p = 0.04) and 82.3 vs. 38.3% controls had blood group 0 (p = 0.003).ConclusionsAB0i LDKT is an effective therapeutic strategy with graft function and survival comparable to AB0c LDKTs, despite higher rates of acute rejection and sepsis. It is an additional opportunity for patients with less chances of being transplanted, as blood group 0 individuals.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 88%

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Outcomes in AB0 Incompatible Living Donor Kidney Transplantation: A Case – Control Study

Cozzi

Donato²,

Ugolini³

et al. 2022

Front. Med.

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“…When comparing this study to a published cohort of equal granularity, the findings are, to an extent, in contrast to an analysis of >100 ABOi-LDKT performed in Freiburg, Germany (12). In this 12) found no differences in patient mortality and graft survival rates when compared to those recorded for a well-matched cohort of ABOc-LDKT.…”

contrasting

confidence: 62%

ABO-Incompatibility: Time to Challenge the Paradigm of Equivalence in Live-Donor Kidney Transplantation?

Eskandary¹,

Böhmig²

2022

Transpl Int

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“…There have been extensive controversies over the outcomes between ABOi LDKT and ABO-compatible (ABOc) LDKT. Although several single-center studies, as well as registry studies, have shown that the outcomes of ABOi LDKT are comparable to those of ABOc LDKD [7][8][9][10][11][12][13], recent meta-analyses have reported inferior outcomes in ABOi LDKT compared with ABOc LDKT, especially in short-term outcomes [14,15]. However, the comparison between ABOi LDKT and ABOc LDKT outcomes may not be fair because ABOi LDKT is performed only for patients without potential ABOc living donors.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of ABO-Incompatible Living Donor Kidney Transplantation Compared to Waiting or Deceased Donor Kidney Transplantation

Koo,

Lee,

Lee

et al. 2023

Am J Nephrol

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Introduction: ABO-incompatible (ABOi) living donor kidney transplantation (LDKT) is considered only for patients who do not have an ABO-compatible (ABOc) LD. Therefore, a clinically practical question is whether to proceed with ABOi LDKT or remain on dialysis while waiting for ABOc deceased donor kidney transplantation (DDKT). However, this issue has not been addressed in Asian countries, where ABOi LDKT programs are more active than DDKT programs. Methods: A total of 426 patients underwent ABOi-LDKT between 2010 and 2020 at Seoul National University Hospital and Severance Hospital, Korea. We compared outcomes between the ABOi-LDKT and the propensity-matched control groups (waiting-list-only group, n = 1,278; waiting-list-or-ABOc-DDKT group, n = 1,278). Results: The ABOi-LDKT group showed a significantly better patient survival rate than the waiting-list-only group (p = 0.001) and the waiting-list-or-ABOc-DDKT group (p = 0.048). When the ABOi-LDKT group was categorized into a high-titer group (peak anti-ABO titer ≥1:128) and a low-titer group (peak anti-ABO titer ≤1:64), the low-titer group showed better patient survival rates than those of the waiting-list-or-ABOc-DDKT group (p = 0.046) or the waiting-list-only group (p = 0.004). In contrast, the high-titer ABOi-LDKT group showed no significant benefit in patient survival compared to the waiting-list-or-ABOc-DDKT group. Death-censored graft survival in the ABOi-LDKT group was not significantly different from that in the ABOc-DDKT group (p = 0.563). Conclusion: The ABOi-LDKT group has better outcomes than the waiting-list-or-ABOc-DDKT group in a country with a long waiting time.

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Long-term Follow-up of ABO-Incompatible Kidney Transplantation in Freiburg, Germany: A Single-Center Outcome Report

Cited by 6 publications

References 23 publications

Outcomes in AB0 Incompatible Living Donor Kidney Transplantation: A Case – Control Study

Outcomes in AB0 Incompatible Living Donor Kidney Transplantation: A Case – Control Study

ABO-Incompatibility: Time to Challenge the Paradigm of Equivalence in Live-Donor Kidney Transplantation?

Outcomes of ABO-Incompatible Living Donor Kidney Transplantation Compared to Waiting or Deceased Donor Kidney Transplantation

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