Open AccessOutcomes and complications following ABO‐incompatible kidney transplantation performed after desensitization by semi‐selective immunoadsorption ‐ a retrospective study
Author(s) -
Speer Claudius,
Kälble Florian,
Nusshag Christian,
Pego da Silva Luiza,
Schaier Matthias,
Becker Luis Eduardo,
Klein Katrin,
Sommerer Claudia,
Beimler Jörg,
Leo Albrecht,
Waldherr Rüdiger,
Mehrabi Arianeb,
Süsal Caner,
Zeier Martin,
Morath Christian
Publication year - 2019
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13482
Subject(s) - medicine , abo blood group system , immunoadsorption , desensitization (medicine) , retrospective cohort study , titer , transplantation , rituximab , kidney transplantation , surgery , incidence (geometry) , immunology , antibody , receptor , physics , optics
Summary Because of the current organ shortage, ABO‐incompatible (ABOi) transplantations have been increasingly performed in recent years. The results seem comparable to those of compatible transplantations, but there have also been reports of increased side effects possibly because of the desensitization therapy. To address an increase in severe infectious complications, we compared the outcomes of 48 ABOi transplant recipients to outcomes of 96 matched ABO‐compatible (ABOc) controls transplanted at Heidelberg University Hospital from August 2005 to April 2018. Over a follow‐up period of 8 years, ABOi transplant recipients had comparable graft and patient survival as well as graft function compared with ABOc patients. T‐cell‐mediated and antibody‐mediated rejections were not different between groups. In ABOi transplant recipients, urosepsis (22.9% vs. 8.5%; P = 0.019) and pneumonia with opportunistic pathogens (8.3% vs. 1.0%, P = 0.025) appeared more frequently. As a consequence, a significantly higher number of deaths from infection have been observed after ABOi transplantations (6.3% vs. 0%, P = 0.010). High‐titer recipients (isoagglutinin titer of ≥1:256) showed a higher incidence of BK virus replication and postoperative bleeding complications. ABO‐incompatible transplantations can be performed with results that are not different from results after ABOc transplantations. However, an increased rate of serious infectious complications must be taken into account.