*Purpose: In response to the ongoing organ shortage, ABO-incompatible (ABOi) renal transplant (RT) provides an alternative option for patients with end-stage kidney disease. Literature suggests that desensitization and higher intensity immunosuppression required for ABOi RT may be associated with increased rates of post-transplant infection. This study aims to compare infectious complications between ABOi and ABO-compatible (ABOc) RT recipients at our institution.

*Methods: This single-center study included recipients of primary RT at UAB Hospital between January 1, 2013, and July 31, 2018. The primary outcome was a composite of bacterial, fungal, viral, opportunistic, and/or surgical site infections. Secondary outcomes include incidence of each infection type, source of infection, inpatient length of stay (LOS), glomerular filtration rate (GFR) and incidence of biopsy-proven acute rejection (BPAR) at 12 months post-transplant.

*Results: A total of 34 ABOi RT recipients were matched 1:2 with ABOc controls based on immunologic risk and transplant characteristics. There was no difference in matched samples except for the calculated panel reactive antibody, which was higher in the ABOi group. All patients received maintenance immunosuppression with tacrolimus, mycophenolate, and steroids. Preliminary results suggest a comparable incidence of composite infections (66.7% vs. 66.7%) with an average rate of 1.53 vs. 1.27 infections per patient for ABOi RT recipients and ABOc controls, respectively. Additionally, there were higher rates of bacterial infections (60.9% vs. 44.7%) and greater LOS (12.5 ± 4.5 days vs. 6.9 ± 2.4 days) in the ABOi group. At 12 months post-transplant, patients with ABOi RT experienced numerically higher rates of BPAR (26.7% vs. 6.7%). Patient survival, graft survival, and GFR were similar between groups. Statistical analysis is ongoing.

*Conclusions: At our center, ABOi RT was associated with a higher average rate of composite infectious complications per patient compared to ABOc matched controls, although the incidence was similar between groups. Preliminary results indicate comparable patient and graft survival at 12 months post-transplant.

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