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Comparative Study
. 2012 Mar 27;93(6):603-9.
doi: 10.1097/TP.0b013e318245b2af.

Outcomes of ABO-incompatible kidney transplantation in the United States

John R Montgomery  1 , Jonathan C Berger, Daniel S Warren, Nathan T James, Robert A Montgomery, Dorry L Segev
Affiliations
Comparative Study

Outcomes of ABO-incompatible kidney transplantation in the United States

John R Montgomery et al. Transplantation. .

Abstract

Background: ABO incompatible (ABOi) kidney transplantation is an important modality to facilitate living donor transplant for incompatible pairs. To date, reports of the outcomes from this practice in the United States have been limited to single-center studies.

Methods: Using the Scientific Registry of Transplant Recipients, we identified 738 patients who underwent live-donor ABOi kidney transplantation between January 1, 1995, and March 31, 2010. These were compared with matched controls that underwent ABO compatible live-donor kidney transplantation. Subgroup analyses among ABOi recipients were performed according to donor blood type, recipient blood type, and transplant center ABOi volume.

Results: When compared with ABO compatible-matched controls, long-term patient survival of ABOi recipients was not significantly different between the cohorts (P=0.2). However, graft loss was significantly higher, particularly in the first 14 days posttransplant (subhazard ratio, 2.34; 95% confidence interval, 1.43-3.84; P=0.001), with little to no difference beyond day 14 (subhazard ratio, 1.28; 95% confidence interval, 0.99-1.54; P=0.058). In subgroup analyses among ABOi recipients, no differences in survival were seen by donor blood type, recipient blood type, or transplant center ABOi volume.

Conclusions: These results support the use and dissemination of ABOi transplantation when a compatible live donor is not available, but caution that the highest period of risk is immediately posttransplant.

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Conflict of interest statement

No conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1. ABO Incompatible Live Donor Transplants in the United States, by Year and Transplant Center: (A) Number of Transplants; (B) National Center-Level Distribution comparing ABO Incompatible (Dashed Line) and ABO Compatible (Solid Line) Transplants
In these Lorenz curves (B), perfect equality is represented by the diagonal reference line. Curves that are located farther to the right represent practices that are less-equally distributed amongst US transplant centers.
FIGURE 1
FIGURE 1. ABO Incompatible Live Donor Transplants in the United States, by Year and Transplant Center: (A) Number of Transplants; (B) National Center-Level Distribution comparing ABO Incompatible (Dashed Line) and ABO Compatible (Solid Line) Transplants
In these Lorenz curves (B), perfect equality is represented by the diagonal reference line. Curves that are located farther to the right represent practices that are less-equally distributed amongst US transplant centers.
FIGURE 2
FIGURE 2. (A) Patient Survival and (B) Graft Loss After LDKT, Comparing ABO Incompatible Recipients (Dashed Line) with ABO Compatible Matched Controls (Solid Line)
ABOc controls were matched to ABOi recipients on presence of diabetes, crossmatch status, recipient age, year of transplant, recipient insurance type, peak percent panel reactive antigen, and years of renal replacement therapy.
FIGURE 2
FIGURE 2. (A) Patient Survival and (B) Graft Loss After LDKT, Comparing ABO Incompatible Recipients (Dashed Line) with ABO Compatible Matched Controls (Solid Line)
ABOc controls were matched to ABOi recipients on presence of diabetes, crossmatch status, recipient age, year of transplant, recipient insurance type, peak percent panel reactive antigen, and years of renal replacement therapy.
See this image and copyright information in PMC

References

    1. Gentry SE, Montgomery RA, Segev DL. Kidney Paired Donation: Fundamentals, Limitations, and Expansions. Am J Kidney Dis. 2011;57(1):144–151. - PubMed
    1. Montgomery RA. Renal transplantation across HLA and ABO antibody barriers: integrating paired donation into desensitization protocols. Am J Transplant. 2010;10(3):449–457. - PubMed
    1. Montgomery RA, Simpkins CE, Segev DL. New options for patients with donor incompatibilities. Transplantation. 2006;82(2):164–165. - PubMed
    1. Gentry S, Montgomery R, Segev D. Blood group O recipients and compatible kidney paired donation. Am J Transplant. 2007;7:392–392.
    1. Segev DL, Kucirka LM, Gentry SE, Montgomery RA. Utilization and outcomes of kidney paired donation in the United States. Transplantation. 2008;86(4):502–510. - PubMed

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