Korean J Transplant.  2023 Nov;37(Suppl 1):S274. 10.4285/ATW2023.F-8871.

Comparison of clinical and pathological features of rejection in ABO-incompatible and ABO-compatible kidney transplantation

• Kim HJ

• KMID: 2551903
• DOI: http://doi.org/10.4285/ATW2023.F-8871

Abstract

Background
ABO-incompatible (ABOi) living donor kidney transplantation (LDKT) is gradually being implemented to overcome the shortage of donor kidneys. Since ABOi LDKT began in 2007 in Korea, there have not been yet sufficient reports regarding the posttransplant long term outcomes including the incidence of rejection of ABOi LDKT. We analyzed the decade of our experiences of ABOi LDKT with comparing ABO-compatible (ABOc) LDKT from the standpoint of rejection and de novo donor-specific alloantibody (DSA).
Methods
We retrospectively analyzed 1,190 living donor kidney transplant recipients between July 2010 and December 2020 at the Severance Hospital. We compared clinical outcomes and rejection type of ABOi LDKT (n=246) with those of ABOc LDKT (n=749).
Results
No significant difference in death-censored graft survival was observed between ABOi KT and ABOc KT (P=0.217). Patient survival after ABOi KT was similar to that after ABOc KT (95.0% vs. 97.3%, respectively; P=0.108). The prevalence of de novo DSA production and biopsy-proven acute T-cell mediated rejection (TCMR) and chronic antibody-mediated rejection (ABMR) were comparable between the two groups. The incidence of biopsy-proven active ABMR was significantly higher ABOi KT than ABOc KT (9.8% [24/246] vs. 5.5% [41/749], respectively; P=0.018). In addition, biopsy-proven acute rejection (BPAR) free survival rate was lower in ABOi KT than ABOc KT (71.8% vs. 76.4%, respectively; P=0.024). Multivariable cox regression confirmed that DR and DQ associated de novo DSA was independently associated BPAR but ABO incompatibility was not a significant risk factor of BPAR after adjustment with covariates.
Conclusions
ABOi LDKT was not inferior to ABOc LDKT for patient survival and graft survival. However, ABO incompatibility was associated with the increased incidence of active ABMR.