Cozzi Martina, Donato Paola, Ugolini Gabriele, Nguefouet Momo Rostand Emmanuel, Nacchia Francesco, Ballarini Zeno, Piccoli Pierluigi, Cantini Maurizio, Caletti Chiara, Andreola Stefano, Gandini Giorgio, Gambaro Giovanni, Boschiero Luigino
Kidney Transplant Center, Department of Surgical Sciences, University and Hospital Trust of Verona, Verona, Italy.
Nephrology Postgraduate School, Department of Medicine, University of Verona, Verona, Italy.
Front Med (Lausanne). 2022 Jul 22;9:932171. doi: 10.3389/fmed.2022.932171. eCollection 2022.
Patients waiting for a kidney transplant by far exceed available organs. AB0 incompatible living donor kidney transplantation (AB0i LDKT) represents an additional therapeutic strategy, but with higher risk for complications. We aimed at evaluating outcomes of AB0i LDKTs compared to compatible (AB0c) controls at our Institution.
Retrospective matched case - control study (1:2) comparing AB0i vs. AB0c LDKTs from March 2012 to September 2021. Considered outcomes: graft function, acute rejection, sepsis, CMV infection, BK virus reactivation, death-censored graft survival, patient survival.
Seventeen AB0i LDKTs matched to 34 AB0c controls. We found excellent graft function, comparable in the two groups, at all considered intervals, with an eGFR (ml/min/1.73 m) of 67 vs. 66 at 1 year ( = 0.41), 63 vs. 64 at 3 years ( = 0.53). AB0i recipients had a statistically significant higher incidence of acute rejection, acute antibody-mediated rejection and sepsis within 30 days ( = 0.016; = 0.02; = 0.001), 1 year ( = 0.012; = 0.02; = 0.0004) and 3 years ( = 0.004; = 0.006; = 0.012) after surgery. There was no difference in CMV infection, BK virus reactivation, death-censored graft survival between the two groups. Patient survival was inferior in AB0i group at 1 and 3 years (88.2 vs. 100%; log-rank = 0.03) due to early death for opportunistic infections. AB0i LDKTs spent longer time on dialysis ( = 0.04) and 82.3 vs. 38.3% controls had blood group 0 ( = 0.003).
AB0i LDKT is an effective therapeutic strategy with graft function and survival comparable to AB0c LDKTs, despite higher rates of acute rejection and sepsis. It is an additional opportunity for patients with less chances of being transplanted, as blood group 0 individuals.
等待肾移植的患者数量远远超过了可获得的器官数量。ABO血型不相容的活体供肾移植（ABOi LDKT）是一种额外的治疗策略，但并发症风险更高。我们旨在评估我院ABOi LDKT与相容性（ABOc）对照的治疗效果。
回顾性配对病例对照研究（1:2），比较2012年3月至2021年9月期间的ABOi与ABOc LDKT。观察指标包括：移植肾功能、急性排斥反应、脓毒症、巨细胞病毒感染、BK病毒再激活、死亡删失的移植肾存活情况、患者存活情况。
17例ABOi LDKT与34例ABOc对照相匹配。我们发现在所有观察时间点，两组的移植肾功能均良好，1年时估算肾小球滤过率（eGFR，ml/min/1.73 m²）分别为67和66（P = 0.41），3年时分别为63和64（P = 0.53）。ABOi受者术后30天（P = 0.016；P = 0.02；P = 0.001）、1年（P = 0.012；P = 0.02；P = 0.0004）和3年（P = 0.004；P = 0.006；P = 0.012）的急性排斥反应、急性抗体介导的排斥反应和脓毒症发生率在统计学上显著更高。两组在巨细胞病毒感染、BK病毒再激活、死亡删失的移植肾存活情况方面无差异。由于机会性感染导致的早期死亡，ABOi组在1年和3年时的患者存活率较低（88.2%对100%；对数秩检验P = 0.03）。ABOi LDKT患者的透析时间更长（P = 0.04），82.3%的ABOi患者血型为O型，而对照组为38.3%（P = 0.003）。
ABOi LDKT是一种有效的治疗策略，尽管急性排斥反应和脓毒症发生率较高，但其移植肾功能和存活率与ABOc LDKT相当。对于像血型为O型这样移植机会较少的患者来说，这是一个额外的机会。
