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

Abstract

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.

Is ABO Incompatible Living Donor Kidney Transplantation in Children a Better Option than the Use of Optimal Grafts From Deceased Donors? A Plea for Better Prioritization of Deceased Kidney Grafts for Children

“…ABOi kidney transplantation carries a higher risk of rejection compared to ABO compatible transplantation, most particularly antibody-mediated rejection [ 2 ]. To overcome this, both extensive pre-transplant conditioning and additional pre-transplant immunosuppressive therapy are required and include desensitization techniques such as antigen-specific immunoadsorption, B cell-depleting monoclonal antibodies (mainly rituximab), and intensified immunosuppression protocols.…”

“…To overcome this, both extensive pre-transplant conditioning and additional pre-transplant immunosuppressive therapy are required and include desensitization techniques such as antigen-specific immunoadsorption, B cell-depleting monoclonal antibodies (mainly rituximab), and intensified immunosuppression protocols. Such complex treatments expose children to a higher risk of bacterial and viral infections [ 2 ], post-transplant lymphoproliferative disease, and other neoplasias. Apheresis techniques require central venous lines in the absence of an arteriovenous fistula, especially in children on peritoneal dialysis or with pre-emptive transplantation, and these procedures can be complicated by infection, thrombosis, or bleeding, and so jeopardize future access to dialysis.…”