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Weerd, A.E. de; Brand, J.A.J.G. van den; Bouwsma, H.; Vries, A.P.J. de; Dooper, I.M.M.; Sanders, J.S.F.; ... ; Baas, M.C. (2021)

ABO-incompatible kidney transplantation in perspective of deceased donor transplantation and induction strategies: a propensity-matched analysis

Article / Letter to editor
Kidney transplant candidates are blood group incompatible with roughly one out of three potential living donors. We compared outcomes after ABO-incompatible (ABOi) kidney transplantation with matched ABO-compatible (ABOc) living and deceased donor transplantation and analyzed different induction regimens. We performed a retrospective study with propensity matching and compared patient and death-censored graft survival after ABOi versus ABOc living donor and deceased donor kidney transplantation in a nationwide registry from 2006 till 2019. 296 ABOi were compared with 1184 center and propensity-matched ABOc living donor and 1184 deceased donor recipients (matching: recipient age, sex, blood group, and PRA). Patient survival was better compared with deceased donor [hazard ratio (HR) for death of HR 0.69 (0.49-0.96)] and non-significantly different from ABOc living donor recipients [HR 1.28 (0.90-1.81)]. Rate of graft failure was higher compared with ABOc living donor transplantation ...Show moreKidney transplant candidates are blood group incompatible with roughly one out of three potential living donors. We compared outcomes after ABO-incompatible (ABOi) kidney transplantation with matched ABO-compatible (ABOc) living and deceased donor transplantation and analyzed different induction regimens. We performed a retrospective study with propensity matching and compared patient and death-censored graft survival after ABOi versus ABOc living donor and deceased donor kidney transplantation in a nationwide registry from 2006 till 2019. 296 ABOi were compared with 1184 center and propensity-matched ABOc living donor and 1184 deceased donor recipients (matching: recipient age, sex, blood group, and PRA). Patient survival was better compared with deceased donor [hazard ratio (HR) for death of HR 0.69 (0.49-0.96)] and non-significantly different from ABOc living donor recipients [HR 1.28 (0.90-1.81)]. Rate of graft failure was higher compared with ABOc living donor transplantation [HR 2.63 (1.72-4.01)]. Rejection occurred in 47% of 140 rituximab versus 22% of 50 rituximab/basiliximab, and 4% of 92 alemtuzumab-treated recipients (P < 0.001). ABOi kidney transplantation is superior to deceased donor transplantation. Rejection rate and graft failure are higher compared with matched ABOc living donor transplantation, underscoring the need for further studies into risk stratification and induction therapy [NTR7587, ].Show less
ABO-incompatible kidney transplantation
alemtuzumab
deceased donor transplantation
living donor transplantation
patient and graft survival
rejection
All authors
Weerd, A.E. de; Brand, J.A.J.G. van den; Bouwsma, H.; Vries, A.P.J. de; Dooper, I.M.M.; Sanders, J.S.F.; Christiaans, M.H.L.; Reekum, F.E. van; Zuilen, A.D. van; Bemelman, F.J.; Nurmohamed, A.S.; Agteren, M. van; Betjes, M.G.H.; Jong, M.F.C. de; Baas, M.C.
Date
2021-11-11
Journal
Transplant International
Volume
34
Issue
12
Pages
2706 - 2719
DOI
doi:10.1111/tri.14145