Ann Surg Treat Res.  2016 Jul;91(1):37-44. 10.4174/astr.2016.91.1.37.

Ongoing higher infection rate in ABO-incompatible kidney transplant recipient: is it a serious problem? A single-center experience

• Choi BH
• Han DJ

• KMID: 2327415
• DOI: http://doi.org/10.4174/astr.2016.91.1.37

Abstract

PURPOSE
Additional clinical experience and knowledge regarding the barrier to transplantation of ABO blood type incompatibility could reduce the higher rate of infectious complications in ABO-incompatible kidney transplantation.
METHODS
A total of 79 ABO-incompatible kidney transplantation (ABOiKT) patients were compared with 260 ABO-compatible kidney transplantation (ABOcKT) patients for basic clinical characteristics, infectious complications, rejection episodes, and graft survival.
RESULTS
There were no significant differences in baseline characteristics, rejection rates, or graft survival between the ABOiKT and ABOcKT patients. No significant difference in the infection rate was shown for cytomegalovirus (26.6% vs. 30.0%; P = 0.672), BK virus (19.0% vs. 21.5%; P = 0.752), herpes disease (10.1% vs. 5.0%; P = 0.082), pneumonia (5.3% vs. 3.8%; P = 0.746), or urinary tract infection (8.9% vs. 10.0%; P > 0.999). Female sex (hazard ratio [HR], 2.20; P = 0.003), advanced age (≥60 years) (HR, 2.5; P = 0.019), history of rejection episodes (HR, 2.28; P = 0.016), and history of surgical complications (HR, 4.64; P = 0.018) were significant risk factors for infection. ABO incompatibility demonstrated a tendency toward higher infection risk without statistical significance (HR, 1.74; P = 0.056).
CONCLUSION
In spite of immunosuppressant protocol modification, the rate of infectious complications following ABOiKT is still higher than with ABOcKT when a modified desensitization protocol is used. However, this was not sufficient to avoid ABOiKT.

Keyword

ABO incompatibility; Kidney transplantation; Infection

MeSH Terms

BK Virus
Cytomegalovirus
Female
Graft Survival
Humans
Kidney Transplantation
Kidney*
Pneumonia
Risk Factors
Transplant Recipients*
Urinary Tract Infections

Figure

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  Fig. 1 Selection of the study cohort. CDC, complement-dependent cytotoxicity.

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  Fig. 2 Immunosuppressant protocols for ABOi and ABOc kidney transplant recipients (after January 2012). MMF, mycophenolate mofetil; PD, prednisolone; LDKT, living donor kidney transplantation; PP, plasmapheresis.

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  Fig. 3 Initial immunosuppressant protocols for ABOi kidney transplant recipients (February 2009-December 2012). KT, kidney transplant; FK, FK 506; MMF, mycophenolate mofetil; PD, prednisolone; LDKT, living donor kidney transplantation; PP, plasmapheresis.

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