Korean J Transplant.  2023 Nov;37(Suppl 1):S151. 10.4285/ATW2023.F-7375.

Clinical outcomes of ABO- and human leukocyte antigen-incompatible living donor kidney transplantation: a nationwide study

• Cho A
• Ko M
• Shin J
• Woo HY
• Han A
• Min S
• Ha J

• KMID: 2551771
• DOI: http://doi.org/10.4285/ATW2023.F-7375

Abstract

Background
ABO-incompatible (ABOi) or human leukocyte antigen-incompatible (HLAi) living donor kidney transplantation (LDKT) is increasing, however, still inferior to immune-compatible transplantation. We aimed to analyze clinical outcomes of ABOi or HLAi LDKT using nationwide cohort data.
Methods
We utilized the nationwide data repository from the Korean Organ Transplantation Registry with the cases of LDKT between 2009 and 2018. The kidney transplants were classified according to the presence of anti-A/B or donor-specific anti-HLA (HLA-DSA) antibodies. We compared the incidence of biopsy-proven acute rejection, graft survival, and patient survival.
Results
A total of 5,046 patients were classified into four groups: transplants in recipients with HLA-DSA and ABOi donors (DSA+ & ABOi, n=192), with HLA-DSA and ABO compatible donors (DSA+ & ABOc, n=320), without HLA-DSA and ABOi donors (DSA- & ABOi, n=1,188), and without HLA-DSA and ABO compatible donors (CONTROL, n=3,346). The incidence of acute antibody-mediated rejection (AABMR) was the highest in the DSA+ & ABOi group, followed by DSA+ & ABOc group, both higher than the CONTROL group (P<0.001, DSA+ & ABOi vs. CONTROL; P<0.001 DSA+ & ABOc vs. CONTROL; P=0.008, DSA- & ABOi vs. CONTROL). The overall 5-year graft survival was 95.5% and was superior in the CONTROL group compared to other groups (P=0.001, DSA+ & ABOi vs. CONTROL; P=0.047, DSA- & ABOi vs. CONTROL). The overall 5-year patient survival was 98.9% and comparable between groups. The multivariable analysis resulted that AABMR (hazard ratio [HR], 4.300; 95% confidence interval [CI], 1.788–10.341; P<0.001), ATCMR (HR, 4.609; 95% CI 1.865–11.389; P<0.001), presence of delayed graft function (HR, 7.119; 95% CI, 2.328–21.767; P=0.001), and severe infection (HR, 2.370; 95% CI, 1.205–4.661; P=0.012) were risk factors of graft loss.
Conclusions
The presence of anti-A/B or donor-specific anti-HLA antibodies had unfavorable impacts on clinical outcomes in LDKT. The appropriate management for risk factors should be undertaken to improve graft and patient survival.