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The Burden of ABO-Incompatible Kidney Transplantation: Readmission Rates and Complications, a Twenty-Year Analysis
Caroline Berchtold1, Kerstin Huebel1, Fabian Roessler1
1Department of Visceral Surgery and Transplantation, University Hospital Zurich, 8091 Zurich, Switzerland.
Journal of Clinical Medicine
|December 17, 2024
Summary
ABO-incompatible live-donor kidney transplantation (ABOi-LDKT) shows comparable outcomes and complication rates to ABO-compatible procedures. This suggests ABOi-LDKT is a safe option and should not be delayed due to perioperative risk concerns.
Area of Science:
- Nephrology
- Transplantation immunology
- Surgical outcomes research
Background:
- ABO-incompatible live-donor kidney transplantation (ABOi-LDKT) is an established treatment for end-stage renal disease.
- Previous studies confirmed non-inferior long-term graft function for ABOi-LDKT compared to ABO-compatible LDKT (ABOc-LDKT).
- The increased morbidity associated with the higher immunosuppression in ABOi-LDKT has not been fully quantified.
Purpose of the Study:
- To assess whether ABOi-LDKT recipients experience additional morbidity compared to ABOc-LDKT recipients.
- To determine if the potential increased burden of complications in ABOi-LDKT is justified by the outcomes.
Main Methods:
- Retrospective analysis of 45 matched pairs of ABOi-LDKTs and ABOc-LDKTs transplanted between January 2000 and March 2020.
- Evaluation of postoperative readmissions, surgical complications (Clavien-Dindo classification and Comprehensive Complication Index - CCI), graft function, new-onset diabetes, infections, and tumor incidence.
- Statistical comparison of complication rates and indices between the two groups.
Main Results:
- Patient and graft survival, along with graft function, were comparable between ABOi-LDKT and ABOc-LDKT groups.
- No significant differences were observed in complication rates, readmission rates or duration, infection rates, or rejection rates.
- Median Comprehensive Complication Index (CCI) scores showed no significant differences between ABOi-LDKT and ABOc-LDKT at various postoperative time points.
Conclusions:
- ABO-incompatible live-donor kidney transplantation (ABOi-LDKT) demonstrates safety comparable to ABO-compatible live-donor kidney transplantation (ABOc-LDKT).
- Outcomes, complication rates, and readmission rates are similar between ABOi-LDKT and ABOc-LDKT.
- Transplantation in recipients with ABOi living donors should not be postponed due to concerns regarding increased perioperative risks.
