Abstract: TH-PO1176
Survival Benefit of HLA-Incompatible Living Donor Kidney Transplantation Compared with Deceased Donor Kidney Transplantation or Dialysis in Korea
Session Information
- Transplantation: Clinical - Pretransplant Management
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Koo, Tai yeon, Seoul National University Hospital, Seoul, Korea (the Republic of)
- Yan, Ji-Jing, Seoul National University Hospital, Seoul, Korea (the Republic of)
- Piao, Honglin, 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 KT opportunity for sensitized ESRD patients. Although removing anti-HLA antibodies may be high risk, to find a compatible LD or wait for a deceased donor(DD) may be long. Recently, there are controversies for outcomes of HLAi KT. US data showed better outcomes of HLAi LDKT compared to HLA-compatible(HLAc) DDKT or dialysis, whereas UK data demonstrated that waiting for HLAc DDKT or HLAc LDKT by donor exchange has good outcomes comparable to HLAi LDKT. Therefore, we tried to compare outcomes of HLAi LDKT with those of DDKT or dialysis in Korea.
Methods
One hundred eighty-nine patients underwent HLAi LDKT after desensitization that consisted of rituximab, plasmapheresis, and intravenous immunoglobulin between 2002 and 2018 in Seoul National University Hospital and Severance Hospital. Indications of desensitization were positive cytotoxicity cross-match, positive flow-cytometric cross-match, and positive donor-specific antibodies with negative cross-match. We compared outcomes among HLAi LDKT patients, DDKT patients(HLAc-DDKT group;n=930), wait-listed patients who had continued to undergo dialysis(dialysis-only group;n=930), or patients who underwent either dialysis or DDKT(dialysis-or-DDKT group;n=930) using propensity score matching.
Results
In the HLAi LDKT group, patient survival rates were 98% at 5-year and 96 % at 7-years post-KT. Patient survival rates at 5- and 7-years in the HLAc-DDKT group were 92%, and 91%, respectively, those in the dialysis-only group were 90%, and 85%, respectively, and those in the dialysis-or-DDKT group were 91%, and 88%, respectively. HLAi LDKT group showed significantly better patient survival rate compared to HLAc-DDKT group, dialysis-only group and dialysis-or-DDKT group. And there was no significant difference in the graft survival rates between HLAi LDKT and HLAc-DDKT group. In multivariate analysis, waiting or DDKT was a significant risk factor for mortality(HR,3.93; 95% CI,1.44-10.74) indepently of old age, diabetes and blood type O.
Conclusion
In conclusion, patients undergoing HLAi LDKT has a survival benefit as compared with patients who were still on the waitlist for HLAc DDKT or received HLAc DDKT in Korea that has longer waiting time for DDKT than Western countries.