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doi: 10.1097/TP.0000000000000312
Clinical and Translational Research: PDF Only

Three-Year Outcomes Following 1,420 ABO-Incompatible Living-Donor Kidney Transplants Performed After ABO Antibody Reduction: Results From 101 Centers.

Opelz, Gerhard; Morath, Christian; Süsal, Caner; Tran, Thuong Hien; Zeier, Martin; Döhler, Bernd

Published Ahead-of-Print
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Background: Reports from experienced centers suggest that recipients of an ABO-incompatible living-donor kidney transplant after reduction of ABO antibodies experience no penalty in graft and patient survival versus ABO-compatible transplants, but confirmation that these results can be widely replicated is lacking.

Methods: Living-donor kidney transplants from ABO-incompatible donors after ABO antibody reduction registered with the Collaborative Transplant Study during 2005 to 2012 were analyzed and compared with (i) a matched group of ABO-compatible transplant recipients and (ii) all ABO-compatible transplants from centers that performed at least five ABO-incompatible grafts during the study period.

Results: One thousand four hundred twenty living-donor ABO-incompatible kidney transplants were analyzed. Three-year death-censored graft survival was virtually identical for ABO-incompatible transplants versus matched and center controls (P=0.92 and P=0.60, respectively). Patient survival rates were also similar (P=0.15 and P=0.11, respectively). Early patient survival was lower in ABO-incompatible grafts (P=0.006 vs. matched controls; P=0.001 vs. center controls) because of a higher rate of early infectious death (P=0.037 and P<0.001, respectively). Death-censored graft and patient survival were not significantly affected by induction therapy and anti-CD20 treatment. ABO antibody reduction by column adsorption was associated with similar death-censored graft survival to plasmapheresis.

Conclusion: In this analysis of prospectively collected data from a large series of ABO-incompatible living-donor kidney transplants performed at 101 centers, death-censored graft and patient survival rates were similar to those achieved in ABO-compatible control groups over the same period.

(C) 2015 by Lippincott Williams & Wilkins





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