Clinical outcomes of ABO- and HLA-incompatible kidney transplantation: a nationwide cohort study

the Korean Organ Transplantation Registry Study Group

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21 Citations (Scopus)

Abstract

This was a nationwide cohort study to investigate the impact of anti-A/B and donor-specific anti-HLA (HLA-DSA) antibodies on the clinical outcomes in kidney transplant recipients (KTRs). We classified a total of 1964 KTRs into four groups: transplants from ABO-incompatible donors (ABOi, n = 248); transplants in recipients with HLA-DSA (HLAi, n = 144); transplants from combined ABOi and HLAi donors (ABOi + HLAi, n = 31); and a control group for whom neither ABOi nor HLAi was applicable (CONT, n = 1541). We compared the incidence of biopsy-proven acute rejection (BPAR), allograft and patient survival rates. The incidence of BPAR was higher in the HLAi and ABOi + HLAi groups relative to the CONT group; in contrast, it was not higher in the ABOi group. Death-censored graft survival rates did not differ across the four groups. However, relative to the CONT group, patient survival rate was reduced in the ABOi and ABOi + HLAi groups, and with infection being the most common cause of death. Further, multivariable analysis revealed that desensitization therapy because of ABOi or HLAi was independent risk factors for patient mortality. HLAi was a more important risk factor for BPAR compared with ABOi. However, pretransplant desensitization therapy for either ABOi or HLAi significantly increased the risk of infection-related mortality.

Original languageEnglish
Pages (from-to)1215-1225
Number of pages11
JournalTransplant International
Volume30
Issue number12
DOIs
Publication statusPublished - 2017 Dec

Bibliographical note

Funding Information:
This study was supported by the Korean Society for Transplantation and by a fund (2014ER630101) from The Research of Korea Centers for Disease Control and Prevention. And also it was supported by a grant (HI13C1232) from The Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea.

Funding Information:
The Korean Organ Transplantation Registry Study Group is comprised of the following individuals: Curie Ahn, Dong Wan Chae and Jaeseok Yang from the Transplantation Center, Seoul National University Hospital; Bum Soon Choi from the Department of Internal Medicine, the Catholic University of Korea; Cheol Woong Jung from the Department of Surgery, Korea University Anam Hospital; Myung Soo Kim from the Department of Surgery, Severance Hospital, Yonsei University College of Medicine; Oh Jung Kwon from the Department of Surgery, Hanyang University Hospital; Sung-Joo Kim from the Department of Surgery, Sam-sung Medical Center, Sungkyunkwan University School of Medicine; Yeong Hoon Kim from the Organ Transplantation Center, Busan Paik Hospital, Inje University College of Medicine; SooJinNa Choi from the Department of Surgery, Chonnam National University; Seung Yeup Han from the Department of Internal Medicine, Keimyung University School of Medicine; Duck Jong Han from the Department of Surgery, Ulsan Medical Center and University of Ulsan College of Medicine; Sang Ho Lee and Kyung Hwan Jeong from Department of Internal Medicine, Kyunghee University College of Medicine; Seung Jung Kim from Department of Internal Medicine, Ewha Womans University Medical Center; Jin Seok Jeon from Department of Internal Medicine, Soon Chun Hyang University Hospital; Yeon Ho Park from the Department of Surgery, Gachon University Gil Medical Center; Young Nam Roh from the Organ Transplantation Center, Inje University Ilsan Paik Hospital; Jeong Joon Lee from the Department of Surgery, CHA Bundang Medical Center, CHA university; Kang Wook Lee from the Department of Internal Medicine, Chungnam National University Hospital; Seung Yeup Han from the Department of Internal Medicine, Kei-myung University Dongsan Medical Center; Chan Duck Kim from the Department of Internal Medicine, Kyung-pook National University Hospital; Jong Won Park from the Department of Internal Medicine, Yeungnam University Hospital; Joong Kyung Kim from the Department of Internal Medicine, Bong Seng Memorial Hospital; Dong Ryeol Lee from the Department of Internal Medicine, Maryknoll medical center; Dong Won Lee and Eun Young Seong from the Department of Internal Medicine, Pusan National University Hospital; Jin Min Kong form the Department of Internal Medicine, BHS Han Seo Hospital; Hong Rae Cho from the Department of Surgery, Ulsan University Hospital ; Sung Kwang Park from the Department of Internal Medicine, Chonbuk National University Hospital; Sam Yeol Lee from the Hallym University Medical Center; Jung Hwan Park from the Department of Internal Medicine, Konkuk University Medical Center. This study was supported by the Korean Society for Transplantation and by a fund (2014ER630101) from the Research of Korea Centers for Disease Control and Prevention. And also it was supported by a grant (HI13C1232) from the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea.

All Science Journal Classification (ASJC) codes

  • Transplantation

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