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ABO-Incompatible Living Kidney Transplants: Evolution of Outcomes and Immunosuppressive Management
Summary
ABO-incompatible living kidney transplantation (ABO-ILKT) outcomes have significantly improved over time. In the last decade, ABO-ILKT graft survival rates are nearly equivalent to ABO-compatible living kidney transplantation (ABO-CLKT).
Area of Science:
- Nephrology
- Transplantation Immunology
- Clinical Outcomes Research
Background:
- ABO-incompatible living kidney transplantation (ABO-ILKT) is increasingly common, yet optimal immunosuppression strategies remain debated.
- Longitudinal data comparing ABO-ILKT and ABO-compatible living kidney transplantation (ABO-CLKT) outcomes are crucial for clinical practice.
Purpose of the Study:
- To evaluate the longitudinal changes in graft survival, patient survival, infectious adverse events, and renal function for ABO-ILKT versus ABO-CLKT over 25 years.
- To compare outcomes between different transplantation eras for ABO-ILKT.
Main Methods:
- Retrospective analysis of 1032 living kidney transplantations (247 ABO-ILKT, 785 ABO-CLKT) performed between 1989 and 2013.
- Patients stratified by transplantation era (1989-2004 vs. 2005-2013) and ABO-compatibility.
- Graft survival, patient survival, infectious events, and renal function analyzed.
Main Results:
- In the past decade, 9-year graft survival rates for ABO-ILKT (86.9%) and ABO-CLKT (92.0%) were comparable (HR 1.38, p=0.455).
- Graft survival for ABO-ILKT improved significantly from 1998-2004 to 2005-2013 (HR 0.30, p=0.007).
- Overall, ABO-ILKT demonstrated substantial improvements in graft survival over time, becoming nearly identical to ABO-CLKT in recent years.
Conclusions:
- ABO-incompatible living kidney transplantation has shown remarkable improvements in graft survival over the last 25 years.
- Current ABO-ILKT outcomes are comparable to ABO-CLKT, particularly in the most recent era.
- ABO-ILKT is now an acceptable and effective treatment option for patients with end-stage renal disease.
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