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Landscape of ABO-Incompatible Live Donor Kidney Transplantation in the US.
J Am Coll Surg. 2018 04; 226(4):615-621.JA

Abstract

BACKGROUND

Widespread implementation of ABO-incompatible (ABOi) living donor kidney transplantation (LDKT) has been proposed as a means to partially ameliorate the national shortage of deceased donor kidneys. Acceptance of this practice has been encouraged by reports from experienced centers demonstrating acute rejection (AR) rates similar to those obtained with ABO-compatible (ABOc) LDKT. Acute rejection rate and graft survival after ABOi LDKT on a national level have yet to be fully determined.

STUDY DESIGN

We studied adult (>18 years) LDKT recipients, from 2000 to 2015, reported to the Scientific Registry of Transplant Recipients. Acute rejection rates in the first post-transplant year (modified Poisson regression) and graft survival (Cox proportional hazards) were assessed by ABO compatibility status (ABOi: 930; ABOc: 89,713).

RESULTS

Patients undergoing ABOi LDKT had an AR rate of 19.4% compared with 10.5% for ABOc recipients (p < 0.0001). After adjusting for recipient- and donor-related risk factors, patients undergoing ABOi LDKT were found to have a 1.76-fold greater risk for AR within 1 year of transplantation compared with ABOc LDKT recipients (adjusted relative risk [aRR] 1.76; 95% CI 1.54 to 2.01). Moreover, there was a 2.34-fold greater risk of death-censored graft loss at 1-year post-transplant among ABOi vs ABOc LDKT recipients (adjusted hazard ratio [aHR] 2.34; 95% CI 1.85 to 2.96).

CONCLUSIONS

Based on these findings, the low rates of AR and excellent short-term graft survival presented in single center series may not be sustainable on a national level. These findings highlight the potential utility for identification of centers of excellence and regionalization of ABOi LDKT.

Links

Authors+Show Affiliations

Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL.

Department of Surgery, Division of Transplantation, University of Louisville, Louisville, KY.

Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL.

Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL.

Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL.

Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL.

Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL.

Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL. Electronic address: jlocke@uabmc.edu.

MeSH

ABO Blood-Group SystemBlood Group IncompatibilityDonor SelectionFemaleGraft RejectionGraft SurvivalHumansKidney TransplantationLiving DonorsMaleMiddle AgedRetrospective StudiesUnited States

Pub Type(s)

Journal Article

Research Support, N.I.H., Extramural

Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

29309944

Citation

Mustian, Margaux N., et al. "Landscape of ABO-Incompatible Live Donor Kidney Transplantation in the US." Journal of the American College of Surgeons, vol. 226, no. 4, 2018, pp. 615-621.

Mustian MN, Cannon RM, MacLennan PA, et al. Landscape of ABO-Incompatible Live Donor Kidney Transplantation in the US. J Am Coll Surg. 2018;226(4):615-621.

Mustian, M. N., Cannon, R. M., MacLennan, P. A., Reed, R. D., Shelton, B. A., McWilliams, D. M., Deierhoi, M. H., & Locke, J. E. (2018). Landscape of ABO-Incompatible Live Donor Kidney Transplantation in the US. Journal of the American College of Surgeons, 226(4), 615-621. https://doi.org/10.1016/j.jamcollsurg.2017.12.026

Mustian MN, et al. Landscape of ABO-Incompatible Live Donor Kidney Transplantation in the US. J Am Coll Surg. 2018;226(4):615-621. PubMed PMID: 29309944.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Landscape of ABO-Incompatible Live Donor Kidney Transplantation in the US. AU - Mustian,Margaux N, AU - Cannon,Robert M, AU - MacLennan,Paul A, AU - Reed,Rhiannon D, AU - Shelton,Brittany A, AU - McWilliams,Deanna M, AU - Deierhoi,Mark H, AU - Locke,Jayme E, Y1 - 2018/01/05/ PY - 2017/12/13/received PY - 2017/12/13/accepted PY - 2018/1/9/pubmed PY - 2019/7/16/medline PY - 2018/1/9/entrez SP - 615 EP - 621 JF - Journal of the American College of Surgeons JO - J Am Coll Surg VL - 226 IS - 4 N2 - BACKGROUND: Widespread implementation of ABO-incompatible (ABOi) living donor kidney transplantation (LDKT) has been proposed as a means to partially ameliorate the national shortage of deceased donor kidneys. Acceptance of this practice has been encouraged by reports from experienced centers demonstrating acute rejection (AR) rates similar to those obtained with ABO-compatible (ABOc) LDKT. Acute rejection rate and graft survival after ABOi LDKT on a national level have yet to be fully determined. STUDY DESIGN: We studied adult (>18 years) LDKT recipients, from 2000 to 2015, reported to the Scientific Registry of Transplant Recipients. Acute rejection rates in the first post-transplant year (modified Poisson regression) and graft survival (Cox proportional hazards) were assessed by ABO compatibility status (ABOi: 930; ABOc: 89,713). RESULTS: Patients undergoing ABOi LDKT had an AR rate of 19.4% compared with 10.5% for ABOc recipients (p < 0.0001). After adjusting for recipient- and donor-related risk factors, patients undergoing ABOi LDKT were found to have a 1.76-fold greater risk for AR within 1 year of transplantation compared with ABOc LDKT recipients (adjusted relative risk [aRR] 1.76; 95% CI 1.54 to 2.01). Moreover, there was a 2.34-fold greater risk of death-censored graft loss at 1-year post-transplant among ABOi vs ABOc LDKT recipients (adjusted hazard ratio [aHR] 2.34; 95% CI 1.85 to 2.96). CONCLUSIONS: Based on these findings, the low rates of AR and excellent short-term graft survival presented in single center series may not be sustainable on a national level. These findings highlight the potential utility for identification of centers of excellence and regionalization of ABOi LDKT. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/29309944/Landscape_of_ABO_Incompatible_Live_Donor_Kidney_Transplantation_in_the_US_ DB - PRIME DP - Unbound Medicine ER -