Impact of ABO-Incompatible Living Donor Kidney Transplantation on Patient Survival

Massie, Allan B.; Orandi, Babak J.; Waldram, Madeleine M.; Luo, Xiaobin; Nguyen, Anh Q.; Montgomery, Robert A.; Lentine, Krista L.; Segev, Dorry L.

doi:10.1053/j.ajkd.2020.03.029

Cited by 29 publications

(30 citation statements)

References 31 publications

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“…On the other hand, 14 potential donors failed to donate their kidneys due to ABO-incompatibility and high titer of anti-ABO antibodies in this study. However, development of effective desensitization technology has markedly improved outcomes of ABO-incompatible living donor kidney transplantation worldwide [20][21][22][23] . The number of ABO-incompatible living donor kidney transplantations in Korea has rapidly increased from 78 cases in 2010 to 709 cases in 2019, which corresponds to 16.4% of all living donor kidney transplantation 9 .…”

Section: Discussionmentioning

confidence: 99%

Barriers to the Donation of Living Kidneys for Kidney Transplantation

Min

Koo

Hwang

et al. 2021

Preprint

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Since the waiting time for deceased donor kidney transplantation continues to increase, living donor kidney transplantation is an important treatment for end stage kidney disease patients. Barriers to living kidney donation have been rarely investigated despite a growing interest in the utilization of living donor transplantation and the satisfaction of donor safety. Here, we retrospectively analyzed 1,658 potential donors and 1,273 potential recipients who visited the Seoul National University Hospital for living kidney transplantation between 2010 and 2017 to study the causes of donation failure. Among 1,658 potential donors, 902 (54.4%) failed to donate kidneys. The average number of potential donors that received work-up was 1.30 ± 0.66 per recipient. Among living donor kidney transplant patients, 75.1% received kidneys after work-up of the first donor and 24.9% needed work-up of two or more donors. Donor-related factors (49.2%) were the most common causes of donation failure, followed by immunologic or size mismatches between donors and recipients (25.4%) and recipient-related factors (16.2%). Interestingly, withdrawal of donation will along with refusal by recipients or family were the commonest causes, suggesting the importance of non-biomedical aspects. The elucidation of the barriers to living kidney donation could ensure more efficient and safer living kidney donation.

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Section: Discussionmentioning

confidence: 99%

Barriers to the Donation of Living Kidneys for Kidney Transplantation

Min

Koo

Hwang

et al. 2021

Preprint

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“…Furthermore, compared with DDKT, we found that patient survival was higher after ABOi LDKT. Although recent study reported ABOi LDKT was superior to waiting DDKT in terms of long‐term survival [15] , no large cohort study has been previously conducted in older patients with ESRD. Considering that waiting list mortality increases in proportion to age [32], the survival gain of ABOi LDKT would be larger in older adults than in younger individuals.…”

Section: Discussionmentioning

confidence: 99%

“…These findings were attributed to ABOi LDKT being associated with a higher risk of rejection because of anti‐blood group antibodies [13] and a higher risk of infectious complications resulting from the need for more potent immunosuppressive treatment [14]. On the other hand, Massie et al recently reported long‐term survival gain of ABOi LDKT compared to remaining waiting list [15]. However, outcomes of ABOi LDKT have not been well investigated in older transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of ABO‐incompatible kidney transplantation in older patients: a national cohort study

et al. 2020

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Background Outcomes of ABO‐incompatible living donor kidney transplantation (ABOi LDKT) in older individuals have not been established. Methods This multicentric observational study, using data from the Korean Organ Transplantation Registry database, included 634 older patients (≥60 years) undergoing kidney transplantation. We compared clinical outcomes of ABOi LDKT (n = 80) with those of ABO‐compatible LDKT (ABOc LDKT, n = 222) and deceased donor kidney transplantation (DDKT, n = 332) in older patients. Results Death‐censored graft survival was similar between the three groups (P = 0.141). Patient survival after ABOi LDKT was similar to that after ABOc LDKT (P = 0.489) but higher than that after DDKT (P = 0.038). In multivariable analysis, ABOi LDKT was not risk factor (hazard ratio [HR] 1.73, 95% confidence interval [CI] 0.29‐10.38, P = 0.548), while DDKT was significant risk factor (HR 3.49, 95% CI 1.01–12.23, P = 0.049) for patient survival. Although ABOi LDKT showed higher biopsy‐proven acute rejection than ABOc LDKT, the difference was not significant after adjustment with covariates. However, ABOi LDKT was significant risk factor for infection (HR 1.66, 95% CI 1.12–2.45, P = 0.012). Conclusions In older patients, ABOi LDKT was not inferior to ABOc LDKT and was superior to DDKT for patient survival. ABOi LDKT can be recommended for older patients, rather than waiting for DDKT.

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“…While kidney donor exchange programs help, there is a patient survival benefit from ABOi kidney transplantation if no ABO‐compatible (ABOc) match is found. 1 The immunological barrier in ABOi transplantation can be overcome by undertaking pretransplant extracorporeal antibody removal therapy (EART), but there are risks associated with ABOi transplantation including early graft loss, postoperative bleeding, and infection. 2 , 3 , 4 , 5 , 6 These complications may relate to the presence of donor‐directed antigen‐specific antibody, the treatments required to remove antibody and inhibit its resynthesis or by using excessively heavy immunosuppression because of presumed risks of ABOi transplantation.…”

Section: Introductionmentioning

confidence: 99%