Bisen Shivani S, Getsin Samantha N, Chiang Po-Yu, Herrick-Reynolds Kayleigh, Zeiser Laura B, Yu Sile, Desai Niraj M, Al Ammary Fawaz, Jackson Kyle R, Segev Dorry L, Massie Allan B
Grossman School of Medicine, New York University, New York, NY.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Transplant Direct. 2022 Oct 18;8(11):e1388. doi: 10.1097/TXD.0000000000001388. eCollection 2022 Nov.
ABO type B and O kidney transplant candidates have increased difficulty identifying a compatible donor for living donor kidney transplantation (LDKT) and are harder to match in kidney paired donation registries. A2-incompatible (A2i) LDKT increases access to LDKT for these patients. To better inform living donor selection, we evaluated the association between A2i LDKT and patient and graft survival.
We used weighted Cox regression to compare mortality, death-censored graft failure, and all-cause graft loss in A2i versus ABO-compatible (ABOc) recipients.
Using Scientific Registry of Transplant Recipients data 2000-2019, we identified 345 A2i LDKT recipients. Mortality was comparable among A2i and ABOc recipients; weighted 1-/5-/10-y mortality was 0.9%/6.5%/24.2%, respectively, among A2i LDKT recipients versus 1.4%/7.7%/22.2%, respectively, among ABOc LDKT recipients (weighted hazard ratio [wHR], 1.04; = 0.8). However, A2i recipients faced higher risk of death-censored graft failure; weighted 1-/5-/10-y graft failure was 5.7%/11.6%/22.4% for A2i versus 1.7%/7.5%/17.2% for ABOc recipients (wHR in year 1 = 3.56; through year 5 = 1.78; through year 10 = 1.55). By comparison, 1-/5-/10-y wHRs for A1-incompatible recipients were 1.96/0.94/0.83.
A2i LDKT is generally safe, but A2i donor/recipient pairs should be counseled about the increased risk of graft failure and be monitored as closely as their A1-incompatible counterparts posttransplant.
ABO血型为B型和O型的肾移植候选者在寻找活体供肾移植（LDKT）的合适供体时难度增加，并且在肾脏配对捐赠登记中更难匹配。A2不相容（A2i）的LDKT增加了这些患者获得LDKT的机会。为了更好地指导活体供体的选择，我们评估了A2i的LDKT与患者和移植物存活率之间的关联。
我们使用加权Cox回归比较A2i与ABO相容（ABOc）受者的死亡率、死亡审查的移植物失败率和全因移植物丢失率。
利用2000 - 2019年移植受者科学登记处的数据，我们确定了345例A2i的LDKT受者。A2i和ABOc受者的死亡率相当；A2i的LDKT受者加权1年/5年/10年死亡率分别为0.9%/6.5%/24.2%，而ABOc的LDKT受者分别为1.4%/7.7%/22.2%（加权风险比[wHR]，1.04；P = 0.8）。然而，A2i受者面临死亡审查的移植物失败风险更高；A2i的1年/5年/10年移植物失败率分别为5.7%/11.6%/22.4%，而ABOc受者分别为1.7%/7.5%/17.2%（第1年的wHR = 3.56；至第5年 = 1.78；至第10年 = 1.55）。相比之下，A1不相容受者的1年/5年/10年wHR分别为1.96/0.94/0.83。
A2i的LDKT总体上是安全的，但对于A2i供体/受者对，应告知其移植物失败风险增加，并在移植后与A1不相容的对应者一样密切监测。
