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Abstract: PO2559

Outcomes of Biopsy-Proven Acute Rejection (BPAR) in ABO-Incompatible Kidney Transplants (ABOi KTx) Compared with a Propensity-Matched Cohort of ABO-Compatible Transplant Recipients (ABOc KTx)

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • S, Sabarinath, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Gupta, Amit, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Patel, Manas Rajan, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Kushwaha, Ravi Shankar, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Prasad, Narayan, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Kaul, Anupama, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Bhadauria, Dharmendra, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Background

Although available outome data is equivocal for its non-inferiority compared to ABOc KTx, the data on graft survival after an BPAR episode are scarce in ABOi KTx.

Methods

Single centre, retrospective study, ESRD patients transplanted between 2014 and 2019 were included. Among 100 ABOi KTx, 37 had BPAR and were included. A matched cohort of 37 ABOc KTx with BPAR were identified as controls from 680 ABOc KTx by propensity score matching (nearest neighbour matching) using recipient age and sex, donor age and sex, donor GFR, HLA match and induction agent used as matching covariates. Rejection rates, BANFF score, response to antirejection treatment, overall graft survival, post rejection graft survival were compared between both the groups.

Results

The hazard ratio for BPAR was 1.4 in ABOi KTx, compared with ABOc KTx. Overall graft survival at 1, 3 and 5 years were 86%, 72% and 50% in ABOi KTx; 97%, 91% and 79% in ABOc KTx, respectively. The post BPAR graft survival at 1 and 3 years were 80% and 63% in ABOi KTx; 92% in both 1 and 3 years in ABOc KTx. ABMR was more common in early period in ABOi KTx and ACR was predominant in late period in both the groups. The response to anti-rejection therapy were similar between two groups, no response group (NR) in the ABOi KTx had the poorest graft outcome, complete response group (CR) in the ABOc KTx had the best graft survival. Between CR, PR (partial response) and NR groups, no histopathological parameters were found significant in ABOi KTx, whereas in ABOc KTx, TI scores were higher in PR compared to CR group.

Conclusion

The graft survival after an acute rejection depends upon response to antirejection therapy. After an episode of acute rejection, the overall post rejection graft survival was inferior in ABOi compared to ABOc KTx.

Graft survival after BPAR according to response