Clinical outcomes of ABO- and HLA-incompatible kidney transplantation: a nationwide cohort study

Abstract

This was a nationwide cohort study to investigate the impact of anti-A/B and donor-specific anti-HLA (HLA-DSA) antibodies on the clinical outcomes in kidney transplant recipients (KTRs). We classified a total of 1964 KTRs into four groups: transplants from ABO-incompatible donors (ABOi, n = 248); transplants in recipients with HLA-DSA (HLAi, n = 144); transplants from combined ABOi and HLAi donors (ABOi + HLAi, n = 31); and a control group for whom neither ABOi nor HLAi was applicable (CONT, n = 1541). We compared the incidence of biopsy-proven acute rejection (BPAR), allograft and patient survival rates. The incidence of BPAR was higher in the HLAi and ABOi + HLAi groups relative to the CONT group; in contrast, it was not higher in the ABOi group. Death-censored graft survival rates did not differ across the four groups. However, relative to the CONT group, patient survival rate was reduced in the ABOi and ABOi + HLAi groups, and with infection being the most common cause of death. Further, multivariable analysis revealed that desensitization therapy because of ABOi or HLAi was independent risk factors for patient mortality. HLAi was a more important risk factor for BPAR compared with ABOi. However, pretransplant desensitization therapy for either ABOi or HLAi significantly increased the risk of infection-related mortality.

Clinical outcomes of kidney transplantation in older end‐stage renal disease patients: A nationwide cohort study

“…Pre‐transplant desensitization for ABO‐incompatible KT or KT in highly sensitized patients has increased significantly recently. Furthermore, the proportion of KT with DSZ in elderly recipients did not differ from that of young recipients in many studies (Table ) . In previous studies, intensified DSZ represented a very important risk factor for severe infection and death.…”

“…Advanced age was also an independent risk factor for all‐cause mortality in the overall study group, which is consistent with previous studies. We investigated infection‐related mortality, the most common cause of patient death during the early‐to‐intermediate post‐transplant period in previous studies . As a result, it was higher in the elderly patients in the overall and both subgroups.…”

“…We assessed the type of induction therapy (T cell‐depleting vs T cell non‐depleting) and the type of main immunosuppressant. The DSZ protocols for ABO‐incompatible KT (ABOi KT) or LDKT in highly sensitized patients were described previously . Briefly, they consisted of rituximab and plasmapheresis with or without intravenous immunoglobulin.…”

Desensitization strategies: is it worth it?

“…Interpreting long‐term risks from the above‐mentioned short‐term studies is not possible. A nationwide cohort analysis of the Korean Transplantation registry investigated the impact of anti‐A/B and donor‐specific anti‐HLA antibodies on clinical outcomes in kidney transplant recipients . Patient survival rate was reduced in patients who underwent incompatible transplants (ABO, HLA, ABO+HLA) compared to standard transplants.…”

Increased risk of infection-associated death with incompatible kidney transplantations

“…In the current issue of Transplant Int , Ko and coworkers present data from 46 kidney transplantation centers reporting to the Korea Organ Transplantation Registry (KOTRY) on the outcomes of 1964 living donor kidney transplant recipients who were transplanted during the period 2009–2012. Outcome of patients desensitized for ABO incompatible ( N = 248), HLA incompatible ( N = 144), or ABO and HLA incompatible ( N = 31) kidney transplantations were compared with outcomes of standard risk recipients ( N = 1541).…”