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
AUTHORS (15)
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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