Allan B Massie1, Babak J Orandi2, Madeleine M Waldram3, Xun Luo3, Anh Q Nguyen3, Robert A Montgomery4, Krista L Lentine5, Dorry L Segev6. 1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD. 2. Department of Surgery, University of California, San Francisco, San Francisco, CA. 3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 4. NYU Langone Medical Center, New York University School of Medicine, New York, NY. 5. Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO. 6. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD; Scientific Registry for Transplant Recipients, Minneapolis, MN. Electronic address: dorry@jhmi.edu.
Abstract
RATIONALE & OBJECTIVE: Compared with recipients of blood group ABO-compatible (ABOc) living donor kidney transplants (LDKTs), recipients of ABO-incompatible (ABOi) LDKTs have higher risk for graft loss, particularly in the first few weeks after transplantation. However, the decision to proceed with ABOi LDKT should be based on a comparison of the alternative: waiting for future ABOc LDKTs (eg, through kidney paired exchange) or for a deceased donor kidney transplant (DDKT). We sought to evaluate the patient survival difference between ABOi LDKTs and waiting for an ABOc LDKT or an ABOc DDKT. STUDY DESIGN: Retrospective cohort study of adults in the Scientific Registry of Transplant Recipients. SETTING & PARTICIPANTS: 808 ABOi LDKT recipients and 2,423 matched controls from among 245,158 adult first-time kidney-only waitlist registrants who did not receive an ABOi LDKT and who remained on the waitlist or received either an ABOc LDKT or an ABOc DDKT, 2002 to 2017. EXPOSURE: Receipt of ABOi LDKT. OUTCOME: Death. ANALYTICAL APPROACH: We compared mortality among ABOi LDKT recipients versus a weighted matched comparison population using Cox proportional hazards regression and Cox models that accommodated for changing hazard ratios over time. RESULTS: Compared with matched controls, ABOi LDKT was associated with greater mortality risk in the first 30 days posttransplantation (cumulative survival of 99.0% vs 99.6%) but lower mortality risk beyond 180 days posttransplantation. Patients who received an ABOi LDKT had higher cumulative survival at 5 and 10 years (90.0% and 75.4%, respectively) than similar patients who remained on the waitlist or received an ABOc LDKT or ABOc DDKT (81.9% and 68.4%, respectively). LIMITATIONS: No measurement of ABO antibody titers in recipients; eligibility of participants for kidney paired donation is unknown. CONCLUSIONS: Transplant candidates who receive an ABOi LDKT and survive more than 180 days posttransplantation experience a long-term survival benefit compared to remaining on the waitlist to potentially receive an ABOc kidney transplant.
RATIONALE & OBJECTIVE: Compared with recipients of blood group ABO-compatible (ABOc) living donor kidney transplants (LDKTs), recipients of ABO-incompatible (ABOi) LDKTs have higher risk for graft loss, particularly in the first few weeks after transplantation. However, the decision to proceed with ABOi LDKT should be based on a comparison of the alternative: waiting for future ABOc LDKTs (eg, through kidney paired exchange) or for a deceased donor kidney transplant (DDKT). We sought to evaluate the patient survival difference between ABOi LDKTs and waiting for an ABOc LDKT or an ABOc DDKT. STUDY DESIGN: Retrospective cohort study of adults in the Scientific Registry of Transplant Recipients. SETTING & PARTICIPANTS: 808 ABOi LDKT recipients and 2,423 matched controls from among 245,158 adult first-time kidney-only waitlist registrants who did not receive an ABOi LDKT and who remained on the waitlist or received either an ABOc LDKT or an ABOc DDKT, 2002 to 2017. EXPOSURE: Receipt of ABOi LDKT. OUTCOME: Death. ANALYTICAL APPROACH: We compared mortality among ABOi LDKT recipients versus a weighted matched comparison population using Cox proportional hazards regression and Cox models that accommodated for changing hazard ratios over time. RESULTS: Compared with matched controls, ABOi LDKT was associated with greater mortality risk in the first 30 days posttransplantation (cumulative survival of 99.0% vs 99.6%) but lower mortality risk beyond 180 days posttransplantation. Patients who received an ABOi LDKT had higher cumulative survival at 5 and 10 years (90.0% and 75.4%, respectively) than similar patients who remained on the waitlist or received an ABOc LDKT or ABOc DDKT (81.9% and 68.4%, respectively). LIMITATIONS: No measurement of ABO antibody titers in recipients; eligibility of participants for kidney paired donation is unknown. CONCLUSIONS: Transplant candidates who receive an ABOi LDKT and survive more than 180 days posttransplantation experience a long-term survival benefit compared to remaining on the waitlist to potentially receive an ABOc kidney transplant.
Authors: Eun Yee Hew; Nicos Kessaris; Jelena Stojanovic; Helen Jones; Martin Christian; Anusha Edwards; David V Milford; Milos Ognjanovic; Mohan Shenoy; Richard J Baker; Stephen D Marks Journal: Pediatr Nephrol Date: 2022-06-13 Impact factor: 3.714
Authors: Jun Young Lee; Sung Hwan Cha; Sung Hwa Kim; Kyung Hwan Jeong; Ku Yong Chung; Hong Rae Cho; Juhan Lee; Kyu Ha Huh; Jaeseok Yang; Myoung Soo Kim; Deok Gie Kim Journal: J Clin Med Date: 2021-12-01 Impact factor: 4.241
Authors: Annelies E de Weerd; Jan A J G van den Brand; Hanneke Bouwsma; Aiko P J de Vries; Ine Ph M M Dooper; Jan-Stephan F Sanders; Maarten H L Christiaans; Franka E van Reekum; Arjan D van Zuilen; Frederike J Bemelman; Azam S Nurmohamed; Madelon van Agteren; Michiel G H Betjes; Margriet F C de Jong; Marije C Baas Journal: Transpl Int Date: 2021-11-11 Impact factor: 3.842