Kidney transplantation with ABO-incompatible donors: A comparison with matched ABO compatible donor transplants

Abstract

Introduction: ABO-incompatible kidney transplantation (ABOiKTx) expands the living donor pool. There is limited long-term outcome data from India especially in comparison with ABO-compatible kidney transplantation (ABOcKTx). Here we report outcomes of the first 100 ABOiKTx compared to ABOcKTx from our center. Methods: Between August 2013 and December 2019, 100 consecutive ABOiKTx were compared with 100 ABOcKTx done during the same period.Controls were matched for age, donor characteristics, HLA mismatches, and date of transplantation. Results: Mean (SD) follow up period was 25.9 ± 20.5 and 27.2 ± 20.6 months in ABOi and ABOcKTx respectively. Patient survival at 1 and 5 years post-transplant was 93.3 and 73.5% vs. 95.4 and 93% ( P = 0.03), while graft survival rates were 85 and 60% vs. 93.1 and 83% in ABOi and ABOcKTx respectively ( P = 0.03). The incidence of antibody-mediated rejections was 15% vs. 4%, and that of T-cell-mediated rejections was 10 vs. 12% respectively. Infections, malignancies, and surgical complications were similar. Level of anti ABO titers, HLA mismatches, recipient age, donor age, and presence of diabetes did not impact graft survival amongst ABOiKTx. The predicted survival and incidence of acute rejections and infections in the later 50 ABOiKTx transplants were better than the first 50 ABOiKTx when compared to their respective controls. Conclusion: Outcomes of ABOiKTx were inferior to ABOcKTx but tends to improve as more experience is gained. Incidence of ABMR was higher but infections and surgical complications were comparable. This data provides evidence that ABOiKTx is viable option for those without a ABO compatible donor.

A Multicenter Retrospective Cohort Study on Management Protocols and Clinical Outcomes After ABO-incompatible Kidney Transplantation in India

“…Table 1 summarizes the baseline characteristics of all ABOiKT procedures performed in this study along with a stratified analysis based on the various ABOiKT protocols used. The median age (interquartile range) of the recipients and donors at the time of ABOiKT was 40 (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)…”

“…These issues are relevant in emerging countries, such as India, where infections are the primary cause of death. Strikingly, all major reports, including national studies of ABOiKT, have originated from the developed world [16][17][18][19][20][21][22][23][24][25][26] with only a few small case series from India [27][28][29][30][31][32][33][34][35][36] and the developing world. [37][38][39] Here, we present a multicenter study aimed at assessing desensitization protocols, complications, and outcomes of ABOiKT that shares details on the approach and potential of ABOiKT, including plausible future modifications when applied in emerging countries.…”

“…These issues are relevant in emerging countries, such as India, where infections are the primary cause of death. Strikingly, all major reports, including national studies of ABOiKT, have originated from the developed world 16-26 with only a few small case series from India 27-36 and the developing world. 37-39…”