Background This is a nationwide cohort study to investigate the impact of anti-A/B antibody or donor specific anti-HLA antibody (HLA-DSA) on the clinical outcomes in kidney transplant recipients (KTRs).

Methods Total 1,964 KTRs were included and we classified them into 4 groups; KTRs from ABO incompatible donor (ABOi, n=248); KTRs who had HLA-DSA (HLAi, n=144); combined ABOi and HLAi (ABOi+HLAi group, n=31); and the control group without ABOi or HLAi (CONT, n=1541). We compared post-transplant clinical outcomes such as the incidence of biopsy proven acute rejection (BPAR), allograft and patient survival rate among four groups.

Results Incidence of BPAR was higher in the HLAi or ABOi+HLAi group than in the CONT group. In contrast, it was not higher in the ABOi group than the CONT group. In addition, HLAi was a significant risk factor for BPAR in multivariate analysis, but ABOi was not. Death-censored graft survival rate did not differ across four groups. However, patient survival rate was lower in the ABOi group and ABOi+HLAi group than the CONT group and the most common cause of death in the former two groups were infection. Furthermore, multivariate analysis revealed that either desensitization due to ABOi or HLAi was independent risk factor for patient death.

Conclusion HLAi was more important risk factor for BPAR than ABOi. However, pre-transplant desensitization because of either ABOi or HLAi significantly increased the risk for infection related mortality; hence effort to decrease infection is important for those patients to improve patient outcome.

CITATION INFORMATION: Ko E, Yu J, Yang C, Chung B, Korean Organ Transplantation Registry (KOTRY) Clinical Outcomes of ABO and HLA Incompatible Kidney Transplantation – Nationwide Cohort Study. Am J Transplant. 2017;17 (suppl 3).

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