Risk Due to ABO Incompatibility and Donor-Recipient Weight Mismatch in Living Donor Kidney Transplantation: A National Cohort Study.

Jun Young Lee,Jaeseok Yang,Myoung Soo Kim,Sung Hwan Cha,Sung Hwa Kim,Hong Rae Cho,Deok Gie Kim,Kyung Hwan Jeong,Kyu Ha Huh,Ku Yong Chung,Juhan Lee

doi:10.3390/jcm10235674

Abstract

The effect of donor-recipient weight mismatch is not well established in ABO-incompatible living donor kidney transplantation (LDKT). A total of 2584 LDKT patients in the Korean Organ Transplantation Registry were classified into four groups according to the presence or absence of ABO incompatibility and donor-recipient weight mismatch (donor-to-recipient weight ratio (DRWR) < 0.8). In a multivariable Cox analysis, the combination of ABO incompatibility and DRWR incompatibility (n = 124) was an independent risk factor for graft survival (HR = 2.73, 95% CI = 1.11–6.70) and patient survival (HR = 3.55, 95% CI = 1.39–9.04), whereas neither factor alone was a significant risk factor for either outcome. The combination of ABO incompatibility and DRWR incompatibility was not an independent risk factor for biopsy-proven graft rejection (HR = 1.27, 95% CI = 0.88–1.82); however, it was an independent risk factor for pneumonia (HR = 2.94, 95% CI = 1.64–5.57). The mortality rate due to infection was higher among patients with both ABO incompatibility and DRWR incompatibility than among patients with neither factor or with either factor alone. The combination of ABO incompatibility and DRWR incompatibility was an independent risk factor for graft and patient survival after LDKT, whereas neither factor alone significantly affected graft or patient survival. Thus, donor-recipient weight matching should be cautiously considered in LDKT with ABO incompatibility.

Highlights

Kidney transplantation (KT) is the best treatment for most patients with end-stage renal disease [1]
Male recipients and female donors were predominant in the ABOc-DRWRi and ABOi-DRWRi groups, reflecting weight differences between the sexes
The body mass index (BMI) of the recipients was naturally higher in the two DRWRi groups than in the DRWR compatibility (DRWRc) groups, whereas that of the donors was vice versa

Summary

Introduction

Kidney transplantation (KT) is the best treatment for most patients with end-stage renal disease [1]. Despite excellent outcomes of ABOi LDKT in an early study [2], there have been conflicting reports regarding the safety of ABOi LDKT compared to that of ABO-compatible living donor KT (ABOc LDKT) [3,4,5,6,7,8,9]. A recent well-designed cohort study demonstrated that patients who underwent ABOi LDKT had improved survival compared with patients that waited for a transplant either from a deceased donor or an ABO-compatible live donor [11]. In this context, further risk analysis of ABOi LDKT in comparison with ABOc LDKT is warranted

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