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. 2022 Oct 18;8(11):e1388.
doi: 10.1097/TXD.0000000000001388. eCollection 2022 Nov.

Patient and Graft Survival After A1/A2-incompatible Living Donor Kidney Transplantation

Shivani S Bisen  1 , Samantha N Getsin  2 , Po-Yu Chiang  1 , Kayleigh Herrick-Reynolds  2 , Laura B Zeiser  1 , Sile Yu  2 , Niraj M Desai  2 , Fawaz Al Ammary  3 , Kyle R Jackson  2 , Dorry L Segev  1   4   5 , Allan B Massie  1   4
Affiliations

Patient and Graft Survival After A1/A2-incompatible Living Donor Kidney Transplantation

Shivani S Bisen et al. Transplant Direct. .

Abstract

ABO type B and O kidney transplant candidates have increased difficulty identifying a compatible donor for living donor kidney transplantation (LDKT) and are harder to match in kidney paired donation registries. A2-incompatible (A2i) LDKT increases access to LDKT for these patients. To better inform living donor selection, we evaluated the association between A2i LDKT and patient and graft survival.

Methods: We used weighted Cox regression to compare mortality, death-censored graft failure, and all-cause graft loss in A2i versus ABO-compatible (ABOc) recipients.

Results: Using Scientific Registry of Transplant Recipients data 2000-2019, we identified 345 A2i LDKT recipients. Mortality was comparable among A2i and ABOc recipients; weighted 1-/5-/10-y mortality was 0.9%/6.5%/24.2%, respectively, among A2i LDKT recipients versus 1.4%/7.7%/22.2%, respectively, among ABOc LDKT recipients (weighted hazard ratio [wHR], 0.811.041.33; P = 0.8). However, A2i recipients faced higher risk of death-censored graft failure; weighted 1-/5-/10-y graft failure was 5.7%/11.6%/22.4% for A2i versus 1.7%/7.5%/17.2% for ABOc recipients (wHR in year 1 = 2.243.565.66; through year 5 = 1.251.782.53; through year 10 = 1.151.552.07). By comparison, 1-/5-/10-y wHRs for A1-incompatible recipients were 0.631.966.08/0.390.942.27/0.390.831.74.

Conclusions: A2i LDKT is generally safe, but A2i donor/recipient pairs should be counseled about the increased risk of graft failure and be monitored as closely as their A1-incompatible counterparts posttransplant.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Number of recorded A2i LDKT per year, 2000–2019. A2i, A2-incompatible; LDKT, living donor kidney transplantation.
FIGURE 2.
FIGURE 2.
Posttransplant outcomes among A2i vs comparable ABOc LDKT recipients. Estimated weighted cumulative incidence of (A) mortality, (B) death-censored graft failure, and (C) all-cause graft loss after kidney transplant among patients who received an A2i or ABOc LDKT. A2i, A2-incompatible; ABOc, ABO-compatible; LDKT, living donor kidney transplantation.
FIGURE 3.
FIGURE 3.
Posttransplant outcomes among A1i vs comparable ABOc LDKT recipients. Estimated weighted cumulative incidence of (A) mortality, (B) death-censored graft failure, and (C) all-cause graft loss after kidney transplant among patients who received an A1i or ABOc LDKT. A1i, A1-incompatible; ABOc, ABO-compatible; LDKT, living donor kidney transplantation.
See this image and copyright information in PMC

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