For the many: permitting deceased donor kidney transplantation across low‐titre blood group antibodies can reduce wait times for blood group B recipients, and improve the overall number of 000<scp>MM</scp>transplants ‐ a multicentre observational cohort study

Manook, Miriam; Mumford, Lisa; Barnett, Nicholas; Osei‐Bordom, Daniel; Sandhu, Bynvant; Veniard, David; Maggs, Tim; Shaw, Olivia; Kessaris, Nicos; Dorling, Anthony; Shah, Sapna; Mamode, Nizam

doi:10.1111/tri.13389

Cited by 7 publications

(6 citation statements)

References 40 publications

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“…To promote ABOi KTx, the Chinese Society of Organ Transplantation and Chinese Transplant Doctor Association published the Clinical Guideline for ABO-Incompatible Living-Donor Kidney Transplantation in 2017 [29]. Although more cases are required for further refinement of these protocols, the main findings of our research are that the use of personalized protocols allows a wider range of patients to benefit from ABOi transplantation, especially those with low initial titers [26].…”

Section: Discussionmentioning

confidence: 98%

Individualized Preconditioning for ABO-Incompatible Living-Donor Kidney Transplantation: An Initial Report of 48 Cases from China

et al. 2020

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Background:ABO-incompatible (ABOi) living-donor kidney transplantation (KTx) is well established in developed countries, but not yet in China. Material/Methods:We developed individualized preconditioning protocols for ABOi KTx based on initial ABO antibody titers. After propensity score matching of ABOi with ABO-compatible (ABOc) KTx, post-transplant outcomes were compared. Results:Between September 2014 and June 2018, 48 ABOi living-donor KTx candidates received individualized preconditioning, and all underwent subsequent KTx (median initial ABO titers: 16 for IgM and 16 for IgG). Thirty-one recipients (64.6%) were preconditioned with rituximab (median dose: 200 mg, range: 100-500 mg). Among 37 patients (77.1%) who received pre-transplant antibody removal, the median number of sessions of antibody removal required to achieve ABOi KTx was 2 (range: 1-5), which was conducted between days -10 and -1. Eleven ABOi recipients (22.9%) were preconditioned with oral immunosuppressants alone. Hyperacute rejection led to the loss of 2 grafts in the ABOi group. After a median follow-up of 27.6 months (ABOi group) and 29.8 months (ABOc group), there were no significant differences in graft/recipient survival, rejection, and infection. There were marginally higher rates of severe thrombocytopenia (<50×10 9 /L) (P=0.073) and delayed wound healing (P=0.096) in ABOi recipients. Conclusions:Our individualized preconditioning protocol evolved as our experience grew, and the short-term clinical outcomes of ABOi KTx did not differ from those of matched ABOc patients. ABOi KTx may be a major step forward in expanding the kidney living-donor pool in China.

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Section: Discussionmentioning

confidence: 98%

Individualized Preconditioning for ABO-Incompatible Living-Donor Kidney Transplantation: An Initial Report of 48 Cases from China

et al. 2020

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“…Indeed, previous studies have shown persistent disparity in organ allocation due to ABO incompatibility. In this context, blood group B and O kidney transplant candidates face additional barriers to transplantation than those with blood types A and AB, resulting in a longer waitlist time and accumulation of candidates on the waitlist 19–23 . Blood group O candidates are only biologically compatible with blood group O donor, whereas blood group O donors are compatible with candidates of all blood group.…”

Section: Introductionmentioning

confidence: 99%

“…In this context, blood group B and O kidney transplant candidates face additional barriers to transplantation than those with blood types A and AB, resulting in a longer waitlist time and accumulation of candidates on the waitlist. [19][20][21][22][23] Blood group O candidates are only biologically compatible with blood group O donor, whereas blood group O donors are compatible with candidates of all blood group. Zero HLA-A, B, DR mismatch donors' kidney might be allocated to potential recipients who belong to other compatible blood groups.…”

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confidence: 99%

ABO‐adjusted cPRA metric for kidney allocation in an Asian‐predominant population

Lau,

Chu,

Tang

et al. 2023

HLA

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Recent studies showed that ABO‐adjusted calculated panel reactive antibody (ABO‐cPRA) may better reflect the histocompatibility level in a multi‐ethnic population, but such data in Asians is not available. We developed an ABO‐adjusted cPRA metric on a cohort of waitlist kidney transplant patients (n = 647, 99% Chinese) in Hong Kong, based on HLA alleles and ABO frequencies of local donors. The concordance between the web‐based ABO‐cPRA calculator and the impact on kidney allocation were evaluated. The blood group distribution for A, B, O and AB among waitlist kidney candidates were 26.2%, 27.5%, 40.1%, and 6.1%, and their chances of encountering incompatible blood group donors were 32.6%, 32.4%, 57.6%, and 0%, respectively. There is poor agreement between web‐based ABO‐cPRA calculator and our locally developed metrics. Over 90% of patients showed an increase in cPRA after ABO adjustment, most notably in those with cPRA between 70% and 79%. Blood group O patients had a much greater increase in cPRA scores after adjustment while patients of blood group A and B had similar increment. 10.6% of non‐AB blood group waitlist patients had ABO‐cPRA elevated to ≥80%. A local ABO‐adjusted cPRA metric is required for Asian populations and may improve equity in kidney distribution for patients with disadvantageous blood groups. The result from the current study potentially helps other countries/localities in establishing their own unified ABO‐cPRA metrics and predict the impact on kidney allocation.

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“…13 KT across the A2 barrier (A2 → O, A2 → B, A2B → B) is believed to be safer than that across the A1 barrier (A1 → O, A1 → B, A1B → B) because A2 kidneys express fewer A antigens on their renal endothelial surfaces. 4,5,14 The Organ Procurement and Transplantation Network (OPTN) introduced a voluntary variance in 2002, allowing A2 and A2B kidneys to be allocated to type B recipients. 2 In 2014, A2-incompatible (A2i) became part of the standard allocation system under the Kidney Allocation System (KAS), provided a certain center-specific anti-A 2 titer threshold was met.…”

mentioning

confidence: 99%

“…

A BO type B and O kidney transplant (KT) candidates experience greater barriers to transplantation than type A and AB candidates, due to decreased chances of ABO compatibility. [1][2][3][4][5][6][7] Type B and O candidates combined represented 70.1% of the kidney waitlist in July 2022 and 63.5% of waitlist additions between January 1995 and June 2022. Type B and O donors, however, represented just 59.4% of deceased donors in 2021.

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mentioning

confidence: 99%

Patient and Graft Survival After A1/A2-incompatible Living Donor Kidney Transplantation

Bisen

Getsin

Chiang

et al. 2022

Transplantation Direct

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Background. ABO type B and O kidney transplant candidates have increased difficulty identifying a compatible donor for living donor kidney transplantation (LDKT) and are harder to match in kidney paired donation registries. A2-incompatible (A2i) LDKT increases access to LDKT for these patients. To better inform living donor selection, we evaluated the association between A2i LDKT and patient and graft survival. Methods. We used weighted Cox regression to compare mortality, death-censored graft failure, and all-cause graft loss in A2i versus ABO-compatible (ABOc) recipients. Results. Using Scientific Registry of Transplant Recipients data 2000–2019, we identified 345 A2i LDKT recipients. Mortality was comparable among A2i and ABOc recipients; weighted 1-/5-/10-y mortality was 0.9%/6.5%/24.2%, respectively, among A2i LDKT recipients versus 1.4%/7.7%/22.2%, respectively, among ABOc LDKT recipients (weighted hazard ratio [wHR], 0.811.041.33; P = 0.8). However, A2i recipients faced higher risk of death-censored graft failure; weighted 1-/5-/10-y graft failure was 5.7%/11.6%/22.4% for A2i versus 1.7%/7.5%/17.2% for ABOc recipients (wHR in year 1 = 2.243.565.66; through year 5 = 1.251.782.53; through year 10 = 1.151.552.07). By comparison, 1-/5-/10-y wHRs for A1-incompatible recipients were 0.631.966.08/0.390.942.27/0.390.831.74. Conclusions. A2i LDKT is generally safe, but A2i donor/recipient pairs should be counseled about the increased risk of graft failure and be monitored as closely as their A1-incompatible counterparts posttransplant.

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For the many: permitting deceased donor kidney transplantation across low‐titre blood group antibodies can reduce wait times for blood group B recipients, and improve the overall number of 000MMtransplants ‐ a multicentre observational cohort study

Cited by 7 publications

References 40 publications

Individualized Preconditioning for ABO-Incompatible Living-Donor Kidney Transplantation: An Initial Report of 48 Cases from China

Individualized Preconditioning for ABO-Incompatible Living-Donor Kidney Transplantation: An Initial Report of 48 Cases from China

ABO‐adjusted cPRA metric for kidney allocation in an Asian‐predominant population

Patient and Graft Survival After A1/A2-incompatible Living Donor Kidney Transplantation

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