Department of Surgery, Yonsei Wonju University College of Medicine, Wonju, South Korea.
Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Transpl Int. 2021 Feb;34(2):290-301. doi: 10.1111/tri.13794. Epub 2020 Dec 31.
Outcomes of ABO-incompatible living donor kidney transplantation (ABOi LDKT) in older individuals have not been established.
This multicentric observational study, using data from the Korean Organ Transplantation Registry database, included 634 older patients (≥60 years) undergoing kidney transplantation. We compared clinical outcomes of ABOi LDKT (n = 80) with those of ABO-compatible LDKT (ABOc LDKT, n = 222) and deceased donor kidney transplantation (DDKT, n = 332) in older patients.
Death-censored graft survival was similar between the three groups (P = 0.141). Patient survival after ABOi LDKT was similar to that after ABOc LDKT (P = 0.489) but higher than that after DDKT (P = 0.038). In multivariable analysis, ABOi LDKT was not risk factor (hazard ratio [HR] 1.73, 95% confidence interval [CI] 0.29-10.38, P = 0.548), while DDKT was significant risk factor (HR 3.49, 95% CI 1.01-12.23, P = 0.049) for patient survival. Although ABOi LDKT showed higher biopsy-proven acute rejection than ABOc LDKT, the difference was not significant after adjustment with covariates. However, ABOi LDKT was significant risk factor for infection (HR 1.66, 95% CI 1.12-2.45, P = 0.012).
In older patients, ABOi LDKT was not inferior to ABOc LDKT and was superior to DDKT for patient survival. ABOi LDKT can be recommended for older patients, rather than waiting for DDKT.
ABO 血型不相容活体供肾移植（ABOi LDKT）在老年患者中的结局尚未确定。
本多中心观察性研究使用韩国器官移植登记数据库的数据，纳入 634 例接受肾移植的老年患者（≥60 岁）。我们比较了 ABOi LDKT（n=80）与 ABO 血型相容的活体供肾移植（ABOc LDKT，n=222）和尸体供肾移植（DDKT，n=332）在老年患者中的临床结局。
死亡风险调整后的移植物存活率在三组间无差异（P=0.141）。ABOi LDKT 后患者存活率与 ABOc LDKT 相似（P=0.489），但高于 DDKT（P=0.038）。多变量分析显示，ABOi LDKT 不是患者存活率的危险因素（风险比 [HR] 1.73，95%置信区间 [CI] 0.29-10.38，P=0.548），而 DDKT 是患者存活率的显著危险因素（HR 3.49，95% CI 1.01-12.23，P=0.049）。虽然 ABOi LDKT 显示出比 ABOc LDKT 更高的活检证实的急性排斥反应，但在调整了协变量后差异无统计学意义。然而，ABOi LDKT 是感染的显著危险因素（HR 1.66，95% CI 1.12-2.45，P=0.012）。
在老年患者中，ABOi LDKT 在患者存活率方面不劣于 ABOc LDKT，优于 DDKT。ABOi LDKT 可推荐用于老年患者，而不必等待 DDKT。
