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

The shortage of ABO-compatible live donors has led to the adoption of ABO-incompatible kidney transplantation (ABOi-KT). Since 2012, our center has conducted ABOi-KT procedures. This study evaluates its effectiveness and short-term outcomes, focusing on surgical complications, predictors of complications, and patient and graft survival rates.

We retrospectively analyzed prospectively maintained data for 123 ABOi-KT procedures from 2012 to 2021. Primary outcomes included peri-operative results, primary functioning grafts (PFG), biopsy-proven acute rejection (BPAR) rates, and 1-year patient and graft survival. Secondary outcomes included surgical complications and predictive factors.

Of 123 patients, 121 (98.4%) achieved PFG. BPAR occurred in 25 patients (20%), with 8.1% experiencing antibody-mediated rejection and 12.2% T-cell-mediated rejection. At a median follow-up of 13 months (IQR: 12-14), 104 patients (85%) retained functioning grafts with a median serum creatinine of 1.1 mg/dL (IQR: 1-1.5) and an estimated glomerular filtration rate (eGFR) of 67.5 mL/min/1.73 m² (IQR: 53-79.6). One-year graft survival was 87%. Surgical complications (HR = 5.4, P = .001) and BPAR (HR = 6, P = .03) significantly impacted graft survival. Patient survival was 98.4%, with a 1-year cumulative survival rate of 99%. Complications were reported in 39 patients (31.7%), primarily infections (18.6%), vascular (13%), and urinary (3.2%). Increased plasmapheresis sessions significantly predicted surgical complications (P = .01).

ABOi-KT is a viable solution for addressing donor shortages, with acceptable survival rates. However, elevated rejection and complication rates highlight the need for better preconditioning and post-transplant protocols.