Background: ABO incompatible (ABOi) live donor kidney transplantation (LDKT) holds the potential for increased access to transplantation for ESRD patients. Concerns remain related to the potential for increased risk of acute rejection (AR). To date, no national studies exist on the risk of AR among ABOi-LDKT patients.

Methods: 79,882 adult LDKT recipients (SRTR 2000-2013) were studied. AR diagnosis within one-year of transplant was the primary outcome. Risk ratios (RRs) were estimated using log-binomial regression. Adjusted analyses included recipient (age, race, PRA, HLA mismatch, and previous KT) and donor (age) characteristics; to account for clustering, transplant center was also included.

Results: 787 (1.0%) ABOi-LDKTs were performed. Incidence of AR was 17.4% among ABOi-LDKTs, compared to 9.4% among ABO compatible (ABOc) LDKTs. ABOi-LDKTs had an associated 1.77-fold increased risk of AR within the first post-transplant year. This increased risk was independent of donor age, recipient race, PRA, and degree of HLA mismatch.

Conclusions: ABOi-LDKT is associated with an increased risk of AR compared to ABOc-LDKT. This risk is independent of other factors known to influence AR rates. Further study is needed to identify best practices that may help mitigate this increased risk.

CITATION INFORMATION: MacLennan P, Kumar V, Reed R, Mompoint-Williams D, Stegner K, Locke J. Risk of Acute Rejection Among ABO Incompatible Living Donor Kidney Recipients. Am J Transplant. 2016;16 (suppl 3).

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