Excellent long term patient and renal allograft survival after ABO-incompatible kidney transplantation: Experience of one center

Table 1 Patient characteristics

	ABOi (n = 30)	ABOc (n = 30)	P-value
Recipient age (yr)	39 ± 11 (16-60)	37 ± 11 (19-64)	ns
Donor age (yr)	59 ± 9 (42-77)	61 ± 11 (41-78)	ns
Recipient gender female/male	8/22	7/23	ns
Donor gender female/male	24/6	19/11	ns
HLA mismatches	2.7 ± 1.2	2.4 ± 1.2	ns
PRAs > 10%	3	3	ns
Time on dialysis (mo)	37 ± 34 (4-132)	19 ± 18 (0-82)	0.014a
ABOi
A-O	12 (40%)
B-O	4 (13.3%)
A-B	2 (6.7%)
B-A	1 (3.3%)
AB-A	5 (16.7%)
AB-B	6 (20%)
Anti-A/B IgG titer at referral (median)	1:64 (1:1-1:128)
No. of pretransplant IA	5.1 ± 3.1 (0-14)
No. of posttrasplant IA	3.3 ± 1.4 (1-7)
Cause of renal failure
Polycystic disease	6 (20%)	1 (3.3%)
Hypertension	1 (3.3%)	1 (3.3%)
Glumerulonephritis	8 (26.7%)	5 (16.7%)
Genetic disorder	3 (10%)	4 (13.3%)
Diabetes	3 (10%)	1 (3.3%)
Unknown	6 (20%)	16 (53.4%)
Other	3 (10%)	2 (6.7%)

All values represent means ± SD (range), unless otherwise stated;

^aP < 0.05. ABOi: ABO-incompatible; ABOc: ABO-compatible; PRAs: Panel reactive antibodies; HLA: Human leukocyte antigen; IA: Immunoadsorption.

Table 2 Graft function, rejection episodes after kidney transplantation

	ABOi (n = 30)	ABOc (n = 30)	P-value
Mean follow-up (mo)	74 (14-114)	78 (13-116)	ns
Serum creatinine (mg/dL)
1 yr after KTx	1.56 ± 0.34	1.53 ± 0.46	ns
3 yr after KTx	1.53 ± 0.37	1.5 ± 0.43	ns
5 yr after KTx	1.6 ± 0.48	1.53 ± 0.55	ns
8 yr after KTx	1.78 ± 0.57	1.76 ± 0.58	ns
eGFR by MDRD (mL/min per 1.73 m2)
1 yr after KTx	56.1 ± 13.4	56.3 ± 16.8	ns
3 yr after KTx	51.5 ± 17.1	56.1 ± 16.1	ns
5 yr after KTx	53.1 ± 17	54.5 ± 17.3	ns
8 yr after KTx	47.3 ± 20.5	44.4 ± 16.4	ns
Rejections
Acute cellular rejection	4 (13.3%)	3 (10%)	ns
Acute antibody - mediated rejection	0 (0%)	0 (0%)	ns

All values represent means ± SD, unless otherwise stated. ABOi: ABO-incompatible; ABOc: ABO-compatible; KTx: Kidney transplantation; eGFR: Estimated glomerular filtration rate; MDRD: Modification of diet in renal disease.

Table 3 Histological findings n (%)

Patients with biopsies	ABOi (n = 18)	ABOc (n = 13)	P-value
Acute tubular injury	2 (11)	3 (23)	ns
Acute cellular rejection	4 (22)	3 (23)	ns
Endarteritis	1 (6)	0 (0)	ns
Acute cellular rejection < 1 yr post transplantation	4 (22)	2 (15)	ns
Acute cellular rejection > 1 yr post transplantation	0 (0)	1 (8)	ns
Acute antibody - mediated rejection with histological signs	0 (0)	0 (0)	ns
Chronic antibody - mediated rejection, C4d (+)	0 (0)	2 (15)	ns
Chronic antibody - mediated rejection, C4d (+) < 1 yr post transplantation without TGL	0 (0)	1 (8)	ns
Chronic antibody - mediated rejection, C4d (+) > 1 yr post transplantation with TGL	0 (0)	1 (8)	ns
C4d+ in peritubular capillaries	9 (50)	2 (15)	ns
CNI toxicity	1 (6)	1 (8)	ns
BK nephropathy	4 (22)	1 (8)	ns
Primary disease recurrence	1 (6)	2 (15)	ns
IF/TA with no evidence of any specific etiology	2 (11)	1 (8)	ns
No findings	4 (22)	2 (15)	ns

ABOi: ABO-incompatible; ABOc: ABO-compatible; TGL: Transplant glomerulopathy; IF/TA: Interstitial fibrosis and tubular atrophy; CNI: Calcineurin inhibitor.

Table 4 Surgical and infectious complication n (%)

	ABOi	ABOc	P-value
	(n = 30)	(n = 30)
Surgical complications
Lemphocele	4 (13.3)	1 (3.3)	ns
Other	2 (6.7)	2 (6.7)	ns
Infectious complications
Bacterial (requiring hospitalization)	15 (50)	17 (56.7)	ns
Bacteraemia	5 (16.7)	4 (13.3)	ns
CMV	1 (3.3)	1 (3.3)	ns
BKV	5 (16.7)	2 (6.7)	ns

ABOi: ABO-incompatible; ABOc: ABO-compatible; CMV: Cytomegalovirus; BKV: BK virus.