ABO-Incompatible Kidney Transplant Outcomes

Weerd, Annelies E. de; Betjes, M.

doi:10.2215/cjn.00540118

Cited by 122 publications

(116 citation statements)

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“…An analysis from the Collaborative Transplant Study (CTS) , comparing 1420 ABOi kidney transplant recipients with matched ABOc standard‐risk recipients, revealed also reduced early patient survival ( P = 0.03) most likely attributable to an increased rate of early deaths by infectious complications. Only recently, a large meta‐analysis of 1346 ABOi compared to 4943 ABOc recipients confirmed these findings . Forty‐nine percent of patient deaths after ABOi transplantation were of infectious origin, while the same number was only 13% in ABOc patients ( P = 0.02).…”

Section: Discussionmentioning

confidence: 99%

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Outcomes and complications following ABO‐incompatible kidney transplantation performed after desensitization by semi‐selective immunoadsorption ‐ a retrospective study

et al. 2019

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Because of 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 because of the desensitization therapy. 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 August 2005 to April 2018. Over a followup period of 8 years, ABOi transplant recipients had comparable graft and patient survival as well as graft function compared with ABOc patients. Tcell-mediated and antibody-mediated rejections were not different between groups. In ABOi transplant recipients, urosepsis (22.9% vs. 8.5%; P = 0.019) and pneumonia with opportunistic pathogens (8.3% vs. 1.0%, P = 0.025) appeared more frequently. As a consequence, a significantly higher number of deaths from infection have been observed after ABOi transplantations (6.3% 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. ABO-incompatible transplantations can be performed with results that are not different from results after ABOc transplantations. However, an increased rate of serious infectious complications must be taken into account.

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Section: Discussionmentioning

confidence: 99%

“…According to the available literature, graft and patient survival rates in ABOi kidney transplant recipients seem to be comparable to survival in recipients of an ABO‐compatible (ABOc) organ . However, a recently published meta‐analysis revealed an increased incidence of death, mainly attributable to severe nonviral infections.…”

Section: Introductionmentioning

confidence: 99%

Outcomes and complications following ABO‐incompatible kidney transplantation performed after desensitization by semi‐selective immunoadsorption ‐ a retrospective study

et al. 2019

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“…This stratification was performed to assess the significance of low‐level pretransplant DSA given recent population‐based studies suggesting that these may be associated with increased ABMR and poorer graft survival . ABOi grafts are also associated with increased TCMR, ABMR, and decreased short‐term graft survival . These recipients were therefore included in the high‐risk group, although we acknowledge that the immunological memory conferred by anti‐ABO antibodies may differ from that associated with pretransplant DSA.…”

Section: Discussionmentioning

confidence: 99%

Development and outcomes of de novo donor-specific antibodies in low, moderate, and high immunological risk kidney transplant recipients

Wan

Chadban

Watson

et al. 2020

American Journal of Transplantation

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De novo donor‐specific antibodies (dnDSA) play an important role in antibody‐mediated rejection (ABMR) and graft failure, yet their development in kidney transplant recipients (KTx) of higher immunological risk has not been characterized. We prospectively determined the incidence of dnDSA at 3 and 12 months posttransplant and assessed their associations with outcomes in recipients stratified by low, moderate, and high immunological risk. Adult KTx were screened for DSA pretransplant, months 3 and 12 posttransplant, and when clinically indicated. Outcomes included incidence of dnDSA, death‐censored graft survival (DCGS), and ABMR. Of 371 recipients, 154 (42%) were transplanted across a pretransplant DSA that became undetectable by 12 months posttransplant in 78% of cases. dnDSA were detected in 16% (95% confidence interval [CI]: 12‐20%) by 3 months and 23% (95% CI: 18‐29%) by 12 months posttransplant. Incidence at 12 months was higher in the moderate (30%) and high‐risk groups (29%) compared to the low‐risk group (16%). dnDSA were associated with an increased risk of ABMR (hazard ratio [HR] 2.2; 95% CI: 1.1‐4.4; P = .04) but were not an independent risk factor for DCGS. In conclusion, dnDSA were more frequent in transplant recipients of higher immune risk and associated with an increased risk of ABMR.

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“…After KT, the long‐term immunosuppressive regimen dampens the patients’ immune surveillance capacities and strongly increases the risk of severe infections and malignancies. This phenomenon is increased in high‐risk transplantation requiring the use of a lymphocyte‐depleting agent . Further, the reconstitution of T cells subsets is biased and influenced by numerous factors, including homeostatic proliferation, which occurs in lymphopenic hosts, as well as the chronic exposure to a high density of alloantigens expressed by the graft .…”

Section: Discussionmentioning

confidence: 99%

T cell reconstitution after lymphocyte depletion features a different pattern of inhibitory receptor expression in ABO- versus HLA-incompatible kidney transplant recipients

Bello

Kamar

Treiner

2020

Clinical and Experimental Immunology

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Summary Chronic antigen stimulation can lead to immune exhaustion (a state of T cell dysfunction). Several phenotypical signatures of T cell exhaustion have been described in various pathological situations, characterized by aberrant expression of multiple inhibitory receptors (IR). This signature has been barely studied in the context of allogenic organ transplantation. We undertook a cross‐sectional analysis of the expression of IR [CD244, CD279, T cell immunoreceptor with immunoglobulin (Ig) and immunoreceptor tyrosine‐based inhibition motif (ITIM) domains (TIGIT) and CD57] and their correlation with cytokine‐producing functions in T cells reconstituting after lymphocyte depletion in patients transplanted from living donors, with preformed donor‐specific antibodies. After ABO incompatible transplantation, T cells progressively acquired a phenotype similar to healthy donors and the expression of several IR marked cells with increased functions, with the exception of TIGIT, which was associated with decreased cytokine production. In stark contrast, T cell reconstitution in patients with anti‐human leukocyte antigen (HLA) antibodies was characterized with an increased co‐expression of IR by T cells, and specifically by an increased expression of TIGIT. Furthermore, expression of these receptors was no longer directly correlated to cytokine production. These results suggest that T cell alloreactivity in HLA‐incompatible kidney transplantation drives an aberrant T cell reconstitution with respect to IR profile, which could have an impact on the transplantation outcome.

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ABO-Incompatible Kidney Transplant Outcomes

Abstract: ABO-incompatible kidney transplant recipients have good outcomes, albeit inferior to center-matched ABO-compatible control patients.

Cited by 122 publications

References 50 publications

Outcomes and complications following ABO‐incompatible kidney transplantation performed after desensitization by semi‐selective immunoadsorption ‐ a retrospective study

Outcomes and complications following ABO‐incompatible kidney transplantation performed after desensitization by semi‐selective immunoadsorption ‐ a retrospective study

Development and outcomes of de novo donor-specific antibodies in low, moderate, and high immunological risk kidney transplant recipients

T cell reconstitution after lymphocyte depletion features a different pattern of inhibitory receptor expression in ABO- versus HLA-incompatible kidney transplant recipients

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