Berchtold Caroline, Huebel Kerstin, Roessler Fabian, Graf Nicole, Dutkowski Philipp, Lehmann Kuno, Mueller Thomas, de Rougemont Olivier
Department of Visceral Surgery and Transplantation, University Hospital Zurich, 8091 Zurich, Switzerland.
Independent Researcher, 8403 Winterthur, Switzerland.
J Clin Med. 2024 Dec 9;13(23):7477. doi: 10.3390/jcm13237477.
: ABO-incompatible live-donor kidney transplantation (ABOi-LDKT) has become an established treatment for end-stage renal disease. Non-inferiority in the long-term graft function compared to ABO-compatible live-donor kidney transplantations (ABOc-LDKTs) has been shown. However, the assumed burden due to complications owing to increased immunosuppression inherent to ABOi-LDKTs has not yet been quantified. The aim of this study was to determine if ABOi-LDKT recipients suffer from additional morbidity and whether the resulting burden is justified. : We retrospectively analyzed 45 matched pairs of ABOi-LDKTs and ABOc-LDKTs transplanted over a twenty-year period from January 2000 to March 2020. The number and duration of postoperative readmissions, surgical complication rates according to Clavien-Dindo and its comprehensive complication index (CCI), kidney function, occurrence of new-onset diabetes, and infections as well as tumor incidence were analyzed. : Patient and graft survival, as well as graft function, were comparable between the two groups. There were no significant differences in terms of complications, readmission rates, and length of readmission, as well as infection and rejection rates. The median CCIs for ABOi-LDKTs and ABOc-LDKTs at primary discharge and 3, 6, 12, and >12 months were 20.9 vs. 20.9 ( = 0.363), 31.4 vs. 33.7 ( = 0.438), 33.7 vs. 33.7 ( = 0.875), 20.9 vs. 33.1 ( = 0.25), and 27.1 vs. 31.9 ( = 0.163), respectively. : ABOi-LDKT seems safe, with comparable outcome, complication, and readmission rates to ABOc-LDKT. In recipients with ABOi living donors, transplantation should not be delayed solely due to concerns over increased perioperative risks.
ABO血型不相容的活体供肾移植（ABOi-LDKT）已成为终末期肾病的一种既定治疗方法。与ABO血型相容的活体供肾移植（ABOc-LDKT）相比，其长期移植肾功能并无劣势。然而，ABOi-LDKT因免疫抑制增加而导致的并发症所带来的假定负担尚未得到量化。本研究的目的是确定ABOi-LDKT受者是否存在额外的发病情况，以及由此产生的负担是否合理。
我们回顾性分析了2000年1月至2020年3月这二十年间移植的45对匹配的ABOi-LDKT和ABOc-LDKT。分析了术后再入院的次数和时长、根据Clavien-Dindo分级的手术并发症发生率及其综合并发症指数（CCI）、肾功能、新发糖尿病的发生率、感染情况以及肿瘤发生率。
两组之间的患者和移植物存活率以及移植物功能相当。在并发症、再入院率、再入院时长以及感染和排斥率方面没有显著差异。ABOi-LDKT和ABOc-LDKT在初次出院时以及3、6、12和>12个月时的CCI中位数分别为20.9对20.9（P = 0.363）、31.4对33.7（P = 0.438）、33.7对33.7（P = 0.875）、20.9对33.1（P = 0.25）以及27.1对31.9（P = 0.163）。
ABOi-LDKT似乎是安全的，其结局、并发症和再入院率与ABOc-LDKT相当。对于有ABOi活体供者的受者，不应仅因担心围手术期风险增加而延迟移植。
