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Impact of ABO-Incompatible Living Donor Kidney Transplantation on Patient Survival.
Am J Kidney Dis. 2020 11; 76(5):616-623.AJ

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.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Massie AB
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
Orandi BJ
Department of Surgery, University of California, San Francisco, San Francisco, CA.
Waldram MM
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Luo X
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Nguyen AQ
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Montgomery RA
NYU Langone Medical Center, New York University School of Medicine, New York, NY.
Lentine KL
Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
Segev DL
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.

MeSH

ABO Blood-Group SystemAdultFemaleFollow-Up StudiesGraft RejectionGraft SurvivalHumansKidney TransplantationLiving DonorsMaleMiddle AgedRegistriesRetrospective StudiesSurvival RateTransplant RecipientsUnited States

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32668318

Citation

Massie, Allan B., et al. "Impact of ABO-Incompatible Living Donor Kidney Transplantation On Patient Survival." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 76, no. 5, 2020, pp. 616-623.
Massie AB, Orandi BJ, Waldram MM, et al. Impact of ABO-Incompatible Living Donor Kidney Transplantation on Patient Survival. Am J Kidney Dis. 2020;76(5):616-623.
Massie, A. B., Orandi, B. J., Waldram, M. M., Luo, X., Nguyen, A. Q., Montgomery, R. A., Lentine, K. L., & Segev, D. L. (2020). Impact of ABO-Incompatible Living Donor Kidney Transplantation on Patient Survival. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 76(5), 616-623. https://doi.org/10.1053/j.ajkd.2020.03.029
Massie AB, et al. Impact of ABO-Incompatible Living Donor Kidney Transplantation On Patient Survival. Am J Kidney Dis. 2020;76(5):616-623. PubMed PMID: 32668318.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of ABO-Incompatible Living Donor Kidney Transplantation on Patient Survival. AU - Massie,Allan B, AU - Orandi,Babak J, AU - Waldram,Madeleine M, AU - Luo,Xun, AU - Nguyen,Anh Q, AU - Montgomery,Robert A, AU - Lentine,Krista L, AU - Segev,Dorry L, Y1 - 2020/07/12/ PY - 2018/06/27/received PY - 2020/03/15/accepted PY - 2020/7/16/pubmed PY - 2020/12/15/medline PY - 2020/7/16/entrez KW - ABO incompatible KW - deceased donor kidney transplantation KW - end-stage renal disease (ESRD) KW - kidney transplant recipient KW - living donor kidney transplantation KW - mortality KW - survival benefit SP - 616 EP - 623 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 76 IS - 5 N2 - 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. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/32668318/Impact_of_ABO_Incompatible_Living_Donor_Kidney_Transplantation_on_Patient_Survival_ DB - PRIME DP - Unbound Medicine ER -