TY - JOUR
T1 - ABO-incompatible kidney transplantation in perspective of deceased donor transplantation and induction strategies
T2 - a propensity-matched analysis
AU - de Weerd, Annelies E
AU - van den Brand, Jan A J G
AU - Bouwsma, Hanneke
AU - de Vries, Aiko P J
AU - Dooper, Ine (Ph.) M. M.
AU - Sanders, Jan-Stephan F
AU - Christiaans, Maarten H L
AU - van Reekum, Franka E
AU - van Zuilen, Arjan D
AU - Bemelman, Frederike J
AU - Nurmohamed, Azam S
AU - van Agteren, Madelon
AU - Betjes, Michiel G H
AU - de Jong, Margriet F C
AU - Baas, Marije C
N1 - This article is protected by copyright. All rights reserved.
PY - 2021/12
Y1 - 2021/12
N2 - BACKGROUND: 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.METHODS: 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.RESULTS: 296 ABOi were compared to 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 to deceased donor (hazard ratio (HR) for death of HR 0.69 [0.49-0.96], and not-significantly different from ABOc living donor recipients (HR 1.28 [0.90-1.81]). Rate of graft failure was higher compared to 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).CONCLUSIONS: ABOi kidney transplantation is superior to deceased donor transplantation. Rejection rate and graft failure are higher compared to matched ABOc living donor transplantation, underscoring the need for further studies into risk stratification and induction therapy.
AB - BACKGROUND: 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.METHODS: 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.RESULTS: 296 ABOi were compared to 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 to deceased donor (hazard ratio (HR) for death of HR 0.69 [0.49-0.96], and not-significantly different from ABOc living donor recipients (HR 1.28 [0.90-1.81]). Rate of graft failure was higher compared to 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).CONCLUSIONS: ABOi kidney transplantation is superior to deceased donor transplantation. Rejection rate and graft failure are higher compared to matched ABOc living donor transplantation, underscoring the need for further studies into risk stratification and induction therapy.
U2 - 10.1111/tri.14145
DO - 10.1111/tri.14145
M3 - Article
C2 - 34687095
SN - 0934-0874
VL - 34
SP - 2706
EP - 2719
JO - Transplant International
JF - Transplant International
IS - 12
ER -