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Early clinical complications after ABO-incompatible live-donor kidney
transplantation: a national study of Medicare-insured recipients
#MMPMID24978035
Lentine KL
; Axelrod D
; Klein C
; Simpkins C
; Xiao H
; Schnitzler MA
; Tuttle-Newhall JE
; Dharnidharka VR
; Brennan DC
; Segev DL
Transplantation
2014[Jul]; 98
(1
): 54-65
PMID24978035
show ga
BACKGROUND: Descriptions of the sequelae of ABO-incompatible (ABOi) kidney
transplantation are limited to single-center reports, which may lack power to
detect important effects. METHODS: We examined U.S. Renal Data System registry
data to study associations of ABOi live-donor kidney transplantation with
clinical complications in a national cohort. Among 14,041 Medicare-insured
transplants in 2000 to 2007, 119 non-donor-A2 ABOi transplants were identified.
A2-incompatible (n=35) transplants were categorized separately. Infection and
hemorrhage events were identified by diagnosis codes on billing claims.
Associations of ABO incompatibility with complications were assessed by
multivariate Cox regression. RESULTS: Recipients of ABOi transplants experienced
significantly (P<0.05) higher incidence of wound infections (12.7% vs. 7.3%),
pneumonia (7.6% vs. 3.8%), and urinary tract infections (UTIs) or pyelonephritis
(24.5% vs. 15.3%) in the first 90 days compared with ABO-compatible recipients.
In adjusted models, ABO incompatibility was associated with twice the risk of
pneumonia (adjusted hazard ratio [aHR], 2.22; 95% confidence interval [CI],
1.14-4.33) and 56% higher risk of UTIs or pyelonephritis (aHR, 1.56; 95% CI,
1.05-2.30) in the first 90 posttransplantation days, and 3.5 times the relative
risk of wound infections in days 91 to 365 (aHR, 3.55; 95% CI, 1.92-6.57). ABOi
recipients, 19% of whom underwent pre- or peritransplant splenectomy, experienced
twice the adjusted risk of early hemorrhage (aHR, 1.96; 95% CI, 1.19-3.24).
A2-incompatible transplantation was associated only with early risk of UTIs or
pyelonephritis. CONCLUSION: ABOi transplantation offers patients with potential
live donors an additional transplant option but with higher risks of infectious
and hemorrhagic complications. Awareness of these complications may help improve
protocols for the management of ABOi transplantation.
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