BACKGROUND: The transplantation of living donor renal allografts across blood group barriers requires protocols to reduce and maintain anti-blood group antibody at safe levels. These protocols lead to an increase in resource utilization and cost of transplantation and may result in increased complications. METHODS: In this retrospective study, we compared 40 ABO-incompatible to 77 matching ABO-compatible living donor renal allografts with respect to complications, resource utilization, and cost from day -14 to 90 days after transplantation. RESULTS: Overall, surgery-related complications and resource utilization were increased in the ABO-incompatible group, primarily due to the desensitization protocol and antibody-mediated rejection. In the absence of rejection, the mean number of complications was similar for both groups. ABO-incompatible kidney transplantation was approximately 38,000 US dollars more expensive than ABO-compatible transplants, but was cost effective when compared to maintaining the patient on dialysis while waiting for a blood group compatible deceased donor kidney. Actuarial graft and patient survival was similar in the two groups. CONCLUSIONS: We conclude that ABO-incompatible living donor kidney transplantation is a viable option for patients whose only donor is blood group incompatible despite the additional resource utilization and cost of therapy.
BACKGROUND: The transplantation of living donor renal allografts across blood group barriers requires protocols to reduce and maintain anti-blood group antibody at safe levels. These protocols lead to an increase in resource utilization and cost of transplantation and may result in increased complications. METHODS: In this retrospective study, we compared 40 ABO-incompatible to 77 matching ABO-compatible living donor renal allografts with respect to complications, resource utilization, and cost from day -14 to 90 days after transplantation. RESULTS: Overall, surgery-related complications and resource utilization were increased in the ABO-incompatible group, primarily due to the desensitization protocol and antibody-mediated rejection. In the absence of rejection, the mean number of complications was similar for both groups. ABO-incompatible kidney transplantation was approximately 38,000 US dollars more expensive than ABO-compatible transplants, but was cost effective when compared to maintaining the patient on dialysis while waiting for a blood group compatible deceased donor kidney. Actuarial graft and patient survival was similar in the two groups. CONCLUSIONS: We conclude that ABO-incompatible living donor kidney transplantation is a viable option for patients whose only donor is blood group incompatible despite the additional resource utilization and cost of therapy.
Authors: Chandy Ellimoottil; Zaojun Ye; Apurba K Chakrabarti; Michael J Englesbe; David C Miller; John T Wei; Amit K Mathur Journal: Urology Date: 2015-09-14 Impact factor: 2.649
Authors: D Axelrod; D L Segev; H Xiao; M A Schnitzler; D C Brennan; V R Dharnidharka; B J Orandi; A S Naik; H Randall; J E Tuttle-Newhall; K L Lentine Journal: Am J Transplant Date: 2016-02-08 Impact factor: 8.086
Authors: Krista L Lentine; David Axelrod; Christina Klein; Christopher Simpkins; Huiling Xiao; Mark A Schnitzler; Janet E Tuttle-Newhall; Vikas R Dharnidharka; Daniel C Brennan; Dorry L Segev Journal: Transplantation Date: 2014-07-15 Impact factor: 4.939