A recent editorial in AJT characterized ABOi transplants as "Twice as Expensive, Half as Good" and challenged the ABOi community to evaluate survival benefit of ABOi transplants, i.e. survival with the ABOi transplant versus waiting for a compatible donor. The goal of this study was to address this major concern to the practice of ABOi transplantation.

METHODS: Using SRTR data on a combined population of adult first-time kidney-only waitlist registrants and ABOi LDKT recipients, we calculated the survival benefit of ABOi LDKT versus conservative therapy (remaining on the waitlist or receiving DDKT) using the Mauger method, treating ABOi LDKT as a time-varying exposure and adjusting for baseline candidate characteristics.

RESULTS: Among 308,846 patients in the study, 577 received ABOi LDKT. Compared to conservative therapy, ABOi LDKT was associated with 3-fold higher mortality risk in the first 30d post-KT, but lower mortality risk past 180d post-KT (Table). ABOi recipients reached a break-even point of mortality risk (time to equal risk) 2.7 months post-KT (Figure 1) and received a survival benefit past 8.0 months (time to equal survival). The long-term survival benefit associated with LDKT did not diminish over time, up through five years post-KT (Figure 2).

CONCLUSIONS: In light of the profound survival benefit associated with ABOi transplantation, ABOi transplantation can be characterized as "Twice as Expensive, Twice as Good" as waiting for ABO-compatible DDKT.

CITATION INFORMATION: Massie A, Lonze B, Anjum S, Luo X, Segev D. Survival Benefit of Living Donor ABOi Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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