ABO incompatible kidney transplantation - an analysis of UNOS Registry data

Background: The ABO incompatible kidney transplants have been performed successfully from large numbers of living donors and some blood type A(2) deceased donors. However, there are few reports to support the feasibility of ABO incompatible transplants from non-A(2) deceased donors. This problem was examined in the United Network for Organ Sharing (UNOS) data file. Patients and methods: The UNOS Registry data of kidney transplants performed between 1995 and 2003 from 256 centers was utilized for Kaplan-Meier curves and log-rank tests to compare graft and functional graft survival rates. Results: Deceased donor transplants from all ABO incompatible donors had the same graft survival rates, as that from ABO compatible donors regardless of whether the blood group incompatibility was A (A(1)), A(2) or B. Graft survival from 201 ABO incompatible donors was 66.9% at 5 yr, compared with 66.7% for ABO compatible donors (p = 0.83). Non-A(2) incompatible donors also yielded comparable survival rates to ABO compatible donors. From living donors, ABO incompatible donors yielded significantly lower graft survival rates than the ABO compatible group, although long-term graft survival rates of those who survived > 1 yr did not differ significantly. Conclusion: Except higher initial graft loss possibility because of insufficient removal of antibodies, non-A(2) kidneys yielded equivalent graft survival rates to ABO compatible transplants. In addition to A(2) incompatibilities, Blood group A(1) and B incompatibilities can also be considered in ABO incompatible transplants.