Background: Many patients with a willing, but incompatible live donor choose to undergo incompatible live donor kidney transplantation (ILDKT) facilitated by desensitization procedures to eliminate donor-specific antibody (DSA). Since circulating DSA has been associated with an increased risk of delayed graft function (DGF), we hypothesized that the risk of DGF in the ILDKT would be increased.

Methods: Using SRTR data linked to patient medical records, we studied adults who underwent LDKT (n=10,259) from 22 US transplant centers (1997-2011), of whom 1,025 were ILDKT. ILDKT recipients were categorized by antibody strength (positive-Luminex/negative-flow, PLNF; positive-flow/negative-cytotoxic crossmatch, PFNC; positive-cytotoxic crossmatch, PCC) measured prior to desensitization. Multivariable logistic regression was used, adjusting for recipient age, sex, race, years on dialysis, number of HLA mismatches, cold ischemia time, BMI, and diabetes and donor age.

Results: Among compatible, PLNF, PFNC, and PCC recipients, we observed DGF in 2.70%, 3.27%, 6.16% and 8.55% of recipients, respectively. After adjustment, there was no evidence of increased DGF odds of PLNF recipients (OR vs. compatible recipients =_0.29 0.71 _1.75, p=0.45). However, the odds of DGF were higher among PFNC recipients (OR = _1.11 1.65 _2.45, p=0.01) and PCC recipients (OR=_1.40 2.20 _3.48, p<0.01).

Conclusion: Kidney transplant recipients who undergo ILDKT are at higher risk of developing DGF, particularly at higher levels of antibody strength. This information can improve pre-operative patient counselling and peri-operative management.

CITATION INFORMATION: Motter J., Massie A., Garonzik Wang J., Jackson K., Luo X., Muzaale A., Orandi B., Segev D. Delayed Graft Function in Live Donor HLA-Incompatible Kidney Transplant Recipients: A Multicenter Study Am J Transplant. 2017;17 (suppl 3).

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