Surgical Complications in ABO-incompatible Kidney Transplantation: A Single-Center Experience

Area of Science:

• Nephrology
• Transplantation Immunology
• Surgical Outcomes

Background:

• The critical shortage of ABO-compatible live kidney donors necessitates alternative strategies like ABO-incompatible kidney transplantation (ABOi-KT).
• Our center has actively performed ABOi-KT since 2012, contributing to the growing body of evidence for this procedure.

Purpose of the Study:

• To evaluate the effectiveness and short-term outcomes of ABOi-KT.
• To identify predictors of surgical complications and assess patient and graft survival rates.

Main Methods:

• Retrospective analysis of prospectively maintained data from 123 ABOi-KT procedures (2012-2021).
• Primary outcomes included peri-operative results, primary functioning grafts (PFG), biopsy-proven acute rejection (BPAR), and 1-year survival.
• Secondary outcomes focused on surgical complications and their predictive factors.

Main Results:

• High PFG rate (98.4%) and 1-year graft survival (87%).
• BPAR occurred in 20% of patients; 1-year patient survival was 99%.
• Surgical complications (31.7%, primarily infections) and BPAR significantly impacted graft survival; increased plasmapheresis predicted complications.

Conclusions:

• ABOi-KT is a feasible option for overcoming donor scarcity, demonstrating acceptable patient and graft survival.
• Elevated rates of rejection and complications underscore the need for optimized preconditioning and post-transplant management protocols.