Abstract: SA-PO1165
Outcomes and Complications Following ABO-Incompatible Kidney Transplantation Performed After Desensitization by Antigen-Unspecific Immunoadsorption Devices
Session Information
- Transplantation: Clinical - Rejection, Recurrent Disease, Incompatibility
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Speer, Claudius, University Hospital Heidelberg, Heidelberg, BW, Germany
- Kälble, Florian, University Hospital Heidelberg, Heidelberg, BW, Germany
- Nusshag, Christian, University Hospital Heidelberg, Heidelberg, BW, Germany
- Schaier, Matthias, University Hospital Heidelberg, Heidelberg, BW, Germany
- Sommerer, Claudia, University Hospital Heidelberg, Heidelberg, BW, Germany
- Zeier, Martin G., University Hospital Heidelberg, Heidelberg, BW, Germany
- Morath, Christian, University Hospital Heidelberg, Heidelberg, BW, Germany
Background
Due to the current organ shortage, ABO incompatible (ABOi) transplantations have been increasingly performed in recent years. The results seem comparable to those of compatible transplantations, but there have also been reports of increased side effects possibly due to the desensitization therapy.
Methods
To address an increase in severe infectious complications, we compared the outcomes of 48 ABOi transplant recipients to outcomes of 96 matched ABO compatible (ABOc) controls transplanted at Heidelberg University Hospital from 2005 to 2018. In addition, we conducted a subanalysis of high-titer (≥1:256) recipients compared to low-titer (<1:256) recipients.
Results
Over a follow-up period of 8 years, ABOi transplant recipients had comparable graft and patient survival as well as graft function compared to ABOc patients. T cell-mediated and antibody-mediated rejections were not different between groups. In ABOi transplant recipients, urosepsis (23% vs. 9%; p=0.019) and pneumonia with opportunistic pathogens (8% vs. 1%, p=0.025) appeared more frequently. As a consequence, a significantly higher number of deaths from infection have been observed after ABOi transplantations (6% vs. 0%, p=0.010). High-titer recipients (isoagglutinin titer of ≥1:256) showed a higher incidence of BK virus replication and postoperative bleeding complications.
Conclusion
ABOi kidney transplant recipients may be safely transplanted, even when they have a high anti-A/B antibody titer before surgery. However, particular attention has to be paid to severe infectious complications. Especially pneumonia causes an increased frequency of deaths from infections in ABOi kidney transplant recipients during early follow-up.