Outcomes of abo-incompatible kidney transplantation: Novel ways of reducing rejection, complications, and cost

Pathak, Vivek; Venkatesan, Madhav; Madhavan, Devdas; Balasundaram, Sreekar; Kuppurajan, N; Kumar, Sampath; Bodonyi-Kovacs, Gabor

doi:10.1016/j.tpr.2023.100127

Cited by 1 publication

(3 citation statements)

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“…Table 1 summarizes the baseline characteristics of all ABOiKT procedures performed in this study along with a stratified analysis based on the various ABOiKT protocols used. The median age (interquartile range) of the recipients and donors at the time of ABOiKT was 40 (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)…”

Section: Baseline Demographicsmentioning

confidence: 99%

“…These issues are relevant in emerging countries, such as India, where infections are the primary cause of death. Strikingly, all major reports, including national studies of ABOiKT, have originated from the developed world [16][17][18][19][20][21][22][23][24][25][26] with only a few small case series from India [27][28][29][30][31][32][33][34][35][36] and the developing world. [37][38][39] Here, we present a multicenter study aimed at assessing desensitization protocols, complications, and outcomes of ABOiKT that shares details on the approach and potential of ABOiKT, including plausible future modifications when applied in emerging countries.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Multicenter Retrospective Cohort Study on Management Protocols and Clinical Outcomes After ABO-incompatible Kidney Transplantation in India

Kute,

Pathak,

Ray

et al. 2023

Transplantation

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Background. There is no robust evidence–based data for ABO-incompatible kidney transplantation (ABOiKT) from emerging countries. Methods. Data from 1759 living donor ABOiKT and 33 157 ABO-compatible kidney transplantations (ABOcKT) performed in India between March 5, 2011, and July 2, 2022, were included in this retrospective, multicenter (n = 25) study. The primary outcomes included management protocols, mortality, graft loss, and biopsy-proven acute rejection (BPAR). Results. Protocol included rituximab 100 (232 [13.18%]), 200 (877 [49.85%]), and 500 mg (569 [32.34%]); immunoadsorption (IA) (145 [8.24%]), IVIG (663 [37.69%]), and no induction 200 (11.37%). Mortality, graft loss, and BPAR were reported in 167 (9.49%), 136 (7.73%), and 228 (12.96%) patients, respectively, over a median follow-up of 36.3 mo. In cox proportional hazard model, mortality was higher with IA (hazard ratio [HR]: 2.53 [1.62–3.97]; P < 0.001), BPAR (HR: 1.83 [1.25–2.69]; P = 0.0020), and graft loss (HR: 1.66 [1.05–2.64]; P = 0.0310); improved graft survival was associated with IVIG (HR: 0.44 [0.26–0.72]; P = 0.0010); higher BPAR was reported with conventional tube method (HR: 3.22 [1.9–5.46]; P < 0.0001) and IA use (HR: 2 [1.37–2.92]; P < 0.0001), whereas lower BPAR was reported in the prepandemic era (HR: 0.61 [0.43–0.88]; P = 0.008). Primary outcomes were not associated with rituximab dosing or high preconditioning/presurgery anti-A/anti-B titers. Incidence of overall infection 306 (17.39%), cytomegalovirus 66 (3.75%), and BK virus polyoma virus 20 (1.13%) was low. In unmatched univariate analysis, the outcomes between ABOiKT and ABOcKT were comparable. Conclusions. Our largest multicenter study on ABOiKT provides insights into various protocols and management strategies with results comparable to those of ABOcKT.

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