Yu Ji Hyun, Chung Byung Ha, Yang Chul Woo
Transplantation research center, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
PLoS One. 2017 Mar 21;12(3):e0173878. doi: 10.1371/journal.pone.0173878. eCollection 2017.
ABO incompatible kidney transplantation (ABOi-KT) is an important approach for overcoming donor shortages. We evaluated the effect of ABOi-KT on living donor KT.
Two nationwide transplantation databases were used. We evaluated the impact of ABOi-KT on overall living donor transplant activity and spousal donation as subgroup analysis. In addition, we compared the clinical outcome between ABOi-KT and ABO compatible KT (ABOc-KT) from spousal donor, and performed a Cox proportional hazards regression analysis to define the risk factors affecting the allograft outcomes.
The introduction of ABOi-KT increased overall living donor KT by 12.2% and its portion was increased from 0.3% to 21.7% during study period. The ABOi-KT in living unrelated KT was two times higher than that of living related donor KT (17.8 vs.9.8%). Spousal donor was a major portion of living unrelated KT (77.6%) and ABOi-KT increased spousal donation from 10% to 31.5% in living donor KT. In addition, increasing rate ABOi-KT from spousal donor was 10 times higher than that of living related donor. The clinical outcome (incidence of acute rejection, allograft function, and allograft and patient survival rates) of ABOi-KT from spousal donor was comparable to that of ABOc-KT. Neither ABO incompatibility nor spousal donor was associated with acute rejection or allograft failure on multivariate analysis.
ABOi-KT increased overall living donor KT, and ABOi-KT from spousal donor is rapidly increasing with favorable clinical outcomes.
ABO血型不相容肾移植（ABOi-KT）是克服供体短缺的重要方法。我们评估了ABOi-KT对活体供肾移植的影响。
使用了两个全国性移植数据库。我们评估了ABOi-KT对整体活体供体移植活动的影响，并将配偶捐赠作为亚组分析。此外，我们比较了配偶供体的ABOi-KT和ABO血型相容肾移植（ABOc-KT）之间的临床结局，并进行了Cox比例风险回归分析以确定影响移植肾结局的危险因素。
在研究期间，ABOi-KT的引入使整体活体供肾移植增加了12.2%，其占比从0.3%增至21.7%。非亲属活体供肾移植中的ABOi-KT比亲属活体供肾移植高出两倍（17.8%对9.8%）。配偶供体是非亲属活体供肾移植的主要部分（77.6%），且ABOi-KT使活体供肾移植中的配偶捐赠从10%增至31.5%。此外，配偶供体的ABOi-KT增长率比亲属活体供体高10倍。配偶供体的ABOi-KT的临床结局（急性排斥反应发生率、移植肾功能、移植肾及患者生存率）与ABOc-KT相当。多因素分析显示，ABO血型不相容和配偶供体均与急性排斥反应或移植肾失败无关。
ABOi-KT增加了整体活体供肾移植，且配偶供体的ABOi-KT正在迅速增加，临床结局良好。
