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

Graft Rejection patient and graft survival Original Articles: Clinical Research ANTIGEN-SPECIFIC IMMUNOADSORPTION ABO Blood-Group System 03 medical and health sciences 0302 clinical medicine ABO-incompatible kidney transplantation Journal Article alemtuzumab Living Donors Humans HIGHLY SENSITIZED PATIENTS RITUXIMAB Retrospective Studies deceased donor transplantation Radboudumc 11: Renal disorders RIHS: Radboud Institute for Health Sciences Transplantation OUTCOMES RENAL-TRANSPLANTATION Graft Survival BARRIER Kidney Transplantation 3. Good health living donor transplantation Blood Group Incompatibility SURVIVAL rejection
DOI: 10.1111/tri.14145 Publication Date: 2021-10-23T00:59:01Z
ABSTRACT
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 [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, www.trialregister.nl].
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