Outcomes of ABO-Incompatible Living Donor Kidney Transplantation Compared to Waiting or Deceased Donor Kidney Transplantation.

IF 4.3 3区医学 Q1 UROLOGY & NEPHROLOGY

American Journal of Nephrology Pub Date : 2024-01-01 Epub Date: 2023-11-30 DOI:10.1159/000535583

Tai Yeon Koo, Juhan Lee, Yonggu Lee, Hyung Woo Kim, Beom Seok Kim, Kyu Ha Huh, Jaeseok Yang

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引用次数: 0

Abstract

Introduction: ABO-incompatible (ABOi) living donor kidney transplantation (LDKT) is considered only for patients who do not have an ABO-compatible (ABOc) LD. Therefore, a clinically practical question is whether to proceed with ABOi LDKT or remain on dialysis while waiting for ABOc deceased donor kidney transplantation (DDKT). However, this issue has not been addressed in Asian countries, where ABOi LDKT programs are more active than DDKT programs.

Methods: A total of 426 patients underwent ABOi-LDKT between 2010 and 2020 at Seoul National University Hospital and Severance Hospital, Korea. We compared outcomes between the ABOi-LDKT and the propensity-matched control groups (waiting-list-only group, n = 1,278; waiting-list-or-ABOc-DDKT group, n = 1,278).

Results: The ABOi-LDKT group showed a significantly better patient survival rate than the waiting-list-only group (p = 0.001) and the waiting-list-or-ABOc-DDKT group (p = 0.048). When the ABOi-LDKT group was categorized into a high-titer group (peak anti-ABO titer ≥1:128) and a low-titer group (peak anti-ABO titer ≤1:64), the low-titer group showed better patient survival rates than those of the waiting-list-or-ABOc-DDKT group (p = 0.046) or the waiting-list-only group (p = 0.004). In contrast, the high-titer ABOi-LDKT group showed no significant benefit in patient survival compared to the waiting-list-or-ABOc-DDKT group. Death-censored graft survival in the ABOi-LDKT group was not significantly different from that in the ABOc-DDKT group (p = 0.563).

Conclusion: The ABOi-LDKT group has better outcomes than the waiting-list-or-ABOc-DDKT group in a country with a long waiting time.

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abo血型不相容的活体肾移植与等待或死亡供体肾移植的结果比较。

导论:ABO-incompatible (ABOi) living donor kidney transplantation (LDKT)只考虑用于没有ABO-compatible (ABOc) LD的患者。因此，一个临床实际问题是，在等待ABOc deceased donor kidney transplantation (DDKT)时，是继续进行ABOi LDKT还是继续透析。然而，这一问题在亚洲国家尚未得到解决，ABOi LDKT项目比DDKT项目更为活跃。方法:2010年至2020年间，共有426例患者在韩国首尔国立大学医院和Severance医院接受了ABOi-LDKT手术。我们比较了ABOi-LDKT和倾向匹配对照组的结果(仅等待名单组，n=1,278;waiting-list-or-ABOc-DDKT组，n=1,278)。结果:ABOi-LDKT组患者生存率显著高于单纯等待名单组(P=0.001)和等待名单组(P=0.048)。将ABOi-LDKT组分为高滴度组(峰值抗abo滴度≥1:128)和低滴度组(峰值抗abo滴度≤1:64)，低滴度组患者生存率高于等候名单组或abc - ddkt组(P=0.046)或仅等候名单组(P=0.004)。相比之下，与等候名单或abc - ddkt组相比，高滴度ABOi-LDKT组在患者生存方面没有显着获益。ABOi-LDKT组与abc - ddkt组的死亡审查移植存活无显著差异(P=0.563)。结论:在等待时间较长的国家，ABOi-LDKT组的预后优于等候名单组或abc - ddkt组。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Nephrology 医学-泌尿学与肾脏学

CiteScore

7.50

自引率

2.40%

发文量

审稿时长

4-8 weeks

期刊介绍： The ''American Journal of Nephrology'' is a peer-reviewed journal that focuses on timely topics in both basic science and clinical research. Papers are divided into several sections, including: