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Abstract: FR-PO763

Impact of ABO-Incompatibility and Early Antibody-Mediated Rejection on Kidney Allograft Outcomes

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Heo, Ga Young, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
  • Kim, Hyo Jeong, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
  • Kim, Kyung Won, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
  • Koh, Hee Byung, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
  • Yang, Jaeseok, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
Background

Early active antibody-mediated rejection (ABMR) has been reported to increase the risk of chronic ABMR and decrease long-term graft survival. Although desensitization has improved the long-term outcome of ABO blood type-incompatible (ABOi) kidney transplantation (KT), ABMR is still an important problem after ABOi KT. However, the impact of early ABMR on long-term outcomes in ABOi KT is not well-known.

Methods

We analyzed patients undergoing living-donor KT from Severance Hospital and Seoul National University Hospital between 2010 and 2019. Patients were categorized into 4 groups based on ABO incompatibility and early ABMR during the first year post-transplant. The primary outcome was a composite kidney outcome, defined as a ≥30% decline in the eGFR from baseline or graft loss. Secondary outcomes were the diagnosis of chronic ABMR and de novo donor specific antigen (DSA) production after 1 year.

Results

There were 1,335 ABOc and 367 ABOi KT patients, with a median follow-up of 6.37 years. In multivariate Cox model, both ABOc with ABMR (HR 1.71, 95% CI 1.14-2.56) and ABOi with ABMR (HR 1.61, 95% CI 1.01-2.55) showed increased risk of composite kidney outcome compared to ABOc without ABMR group. However, ABOi without ABMR group did not show significant difference on risk of composite kidney outcome. In parallel, ABOi without ABMR group had a lower risk for the de novo DSA (HR 0.52, 95% CI 0.34-0.79) and chronic ABMR (HR 0.35, 95% CI 0.12-0.98) than ABOc without ABMR.

Conclusion

Our findings suggest that desensitization in ABOi KT might reduce de novo DSA production and chronic ABMR, as well as mitigate the adverse impact of anti-ABO antibody on long-term graft outcome. However, early ABMR in ABOi abrogates these beneficial effects and contributes to poor graft outcome.

Multivariate analyses for composite kidney outcome, de novo DSA, and late chronic ABMR according to categories based on ABO incompatibility and the early ABMR.
 Composite kidney outcomede novo DSALate chronic ABMR
HRs (95% CI)PHRs (95% CI)PHRs (95% CI)P
ABOc without ABMRRefRefRef
ABOc with ABMR1.71 (1.14-2.56)<0.0012.66 (1.74-4.07)<0.0016.70 (3.71-12.0)<0.001
ABOi without ABMR1.12 (0.89-1.41)0.300.52 (0.34-0.79)0.0020.35 (0.12-0.98)0.04
ABOi with ABMR1.61 (1.01-2.55)0.041.38 (0.68-2.82)0.362.58 (0.92-7.20)0.07

Adjusted for age, sex, donor age, HLA mismatches, induction drugs, calcineurin inhibitors and hospital.