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Three-Year Outcomes Following 1420 ABO-Incompatible Living-Donor Kidney Transplants Performed After ABO Antibody Reduction: Results From 101 Centers

Opelz, Gerhard1; Morath, Christian2; Süsal, Caner1; Tran, Thuong Hien1; Zeier, Martin2; Döhler, Bernd1

doi: 10.1097/TP.0000000000000312
Original Clinical Science

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.

This large multicenter registry study of ABO-incompatible transplants show patient and graft survival equivalent to ABO-compatible transplantation, similar outcomes for column adsorption and plasmapheresis, and no greater adverse outcomes specifically associated with anti-CD20 use.

1 Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany.

2 Department of Transplantation Nephrology, University of Heidelberg, Heidelberg, Germany.

Received 21 March 2014. Revision requested 3 April 2014.

Accepted 21 May 2014.

The authors declare no funding or conflicts of interest.

G.O. participated in developing and managing the database, data analysis and interpretation, and wrote the final version of this manuscript. He had full access to all the data in the study and had the final responsibility for submitting this article for publication. C.M., C.S., T.H.T., and M.Z. contributed to the design of the analysis and interpretation of the results. B.D. participated in developing and managing the database, data analysis, and interpretation.

Correspondence: Gerhard Opelz, MD, Department of Transplantation Immunology, University of Heidelberg, Im Neuenheimer Feld 305, D-69120 Heidelberg, Germany. (

Accepted July 22, 2014

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