Early Clinical Complications Following HLA-Incompatible Living Donor Kidney Transplantation

J. D. Motter¹, K. Jackson¹, A. Massie¹, J. Garonzik-Wang², D. Segev¹

¹Johns Hopkins University, Baltimore, MD, ²University of Wisconsin-Madison, Madison, WI

Meeting: 2022 American Transplant Congress

Abstract number: 400

Keywords: HLA antibodies, Kidney, Post-operative complications, Surgical complications

Topic: Clinical Science » Kidney » 36 - Kidney Immunosuppression: Desensitization

Session Information

Session Name: Kidney Immunosuppression: Desensitization & Acute Antibody Mediated Rejection

Session Type: Rapid Fire Oral Abstract

Date: Tuesday, June 7, 2022

Session Time: 3:30pm-5:00pm

Presentation Time: 3:30pm-3:40pm

Location: Hynes Ballroom A

*Purpose: Incompatible living donor kidney transplant recipients (ILDKTr) require desensitization to facilitate transplantation across donor-specific antibody (DSA); however, this substantial upfront immunosuppression may result in higher risk of early complications following surgery.

*Methods: We compared 682 ILDKT to 5685 compatible LDKT (CLDKTr) Medicare-primary recipients drawn from a 25-center cohort with novel linkage to the United States Renal Data System from 1999-2014. We characterized DSA strength as positive-Luminex, negative-flow crossmatch (PLNF, n=129); positive-flow, negative-cytotoxic crossmatch (PFNC, n=349); or positive-cytotoxic crossmatch (PCC, n=204). Diagnoses of deep vein thrombosis (DVT), wound infection, hemorrhage, sepsis, pneumonia, and urinary tract infection (UTI) were ascertained using ICD-9 codes. We used weighted by the odds Cox regression models to quantify the risk of early complications in the first three months, and from three months to one-year post-transplant.

*Results: Compared to CLDKTr, ILDKTr had higher incidence of DVT (14.4% vs. 8.4%), wound infection (15.0% vs. 8.7%), hemorrhage (19.2% vs. 9.3%), sepsis (27.7% vs 20.8%), pneumonia (35.5% vs. 22.9%), and UTI (44.7% vs. 33.5%) (p for all comparisons<0.001) (Figure 1). Within the first three months, a higher risk of DVT (wHR PLNF=_0.050.45_3.93;PFNC=_0.941.79_3.39;PCC=_1.001.88_3.52), wound infection (wHR PLNF=_0.691.23_2.19;PFNC=_1.241.60_2.06;PCC=_0.801.69_3.62), and hemorrhage (PLNF=_1.111.96_3.47;PFNC=_0.911.82_3.65;PCC=_2.072.96_4.21) were observed across varying levels of DSA strength; however, the risk of these complications decreased thereafter. Although there was no evidence of increased risk of sepsis with the first three months, this risk subsequently increased (wHR PLNF=_0.811.87_4.28;PFNC=_0.991.50_2.30;PCC=_1.102.31_4.81). In contrast, there was higher risk of pneumonia that persisted throughout both time periods (0-3 months wHR PLNF=_0.851.91_4.29; PFNC=_1.142.07_3.75;PCC=_1.342.73_5.59; >3 months wHR PLNF=_1.241.57_1.99;PFNC=_0.811.42_2.49;PCC=_1.051.91_3.48).

*Conclusions: Providers should consider these risks during pre-operative counselling, and awareness may aid to improve protocols for ILDKT patient management.

To cite this abstract in AMA style:

Motter JD, Jackson K, Massie A, Garonzik-Wang J, Segev D. Early Clinical Complications Following HLA-Incompatible Living Donor Kidney Transplantation [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/early-clinical-complications-following-hla-incompatible-living-donor-kidney-transplantation/. Accessed May 18, 2025.

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