Abstract: FR-PO1020

Outcomes of HLA-Incompatible Living Donor Kidney Transplantation Compared to Deceased Donor Kidney Transplantation or Dialysis and HLA-Compatible Living Donor Kidney Transplantation

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Koo, Tai yeon, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Ryu, Jung-hwa, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Yan, Ji-Jing, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Min, Kyungok, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Yang, Jaeseok, Seoul National University Hospital, Seoul, Korea (the Republic of)
Background

HLA-incompatible(HLAi) living donor(LD) kidney transplantation(KT) is one of efforts to increase opportunity for sensitized end-stage renal disease patients due to organ shortage. Recently there are controversies for outcomes of HLAi KT. US data showed better outcomes of HLAi LDKT compared to HLA-compatible(HLAc) deceased donor(DD) KT or dialysis, whereas UK data demonstrated that waiting for DDKT or HLAc LDKT has good outcomes comparable to HLAi LDKT. Therefore, we tried to compare outcomes of HLAi LDKT with those of DDKT or dialysius, and HLAc LDKT in Korea

Methods

Forty-eight patients underwent HLAi LDKT after desensitization between 2006 and 2017. Indications of desensitization were positive complement-dependent cytotoxicity cross-match, positive flow-cytometric cross-match, high panel-reactive antibody tests, and positive donor-specific antibodies. We compared outcomes among HLAi LDKT patients, wait-listed patients who had continued to undergo dialysis(n=2047), patients who underwent either dialysis or DDKT(dialysis-or-transplantation group; n=2610), DDKT patients(n=563) and HLAc LDKT patients(n=654).

Results

In the HLAi LDKT group, patient survival rates were 97.8% at 1 year, 97.8% at 5 years and 97.8% at 8 years, as compared with rates of 98.4%, 96.4%, and 94.8% respectively in dialysis-group, rates of 98.3%, 97.2%, and 95.2% repectively in dialysis-or-transplantation group, rates of 99.7%, 99.4% and 98.6% respectively in LDKT group. There was no significant difference in patients survival rate among the groups. Although 6-month graft survival rate in HLAi LDKT was worse than that in HLAc LDKT, there was no significant difference in graft survival rates after 6 months between HLAi LDKT and any other group. Patient and graft survival rate of HLAc LDKT were better than dialysis or DDKT. In safety aspects, incidence of either antibody-mediated rejection or infectious complication did not differ among the groups.

Conclusion

In conclusion, outcomes of HLAi LDKT were comparable with those of dialysis or DDKT, dialysis alone, and HLAc LDKT. Therefore, we should consider many factors such as outcomes of dialysis, mean waiting time for HLAc DDKT, donor exchange program and experience of desensitization before decision of HLAi LDKT in sensitized candidates.