Effect of simultaneous presence of anti-blood group A/B and -HLA antibodies on clinical outcomes in kidney transplantation across positive crossmatch: a nationwide cohort study

the Korean Organ Transplantation Registry Study Group

Research output: Contribution to journalArticle

Abstract

ABO-incompatible (ABOi) and positive crossmatch (XM) kidney transplantation (KT) have been considered immunologically challenging. The present study analyzed the clinical outcomes in XM positive KT based on ABO incompatibility. We used data from the Korea Organ Transplantation Registry, a nationwide database, and a single-center registry. A total of 263 patients with positive XM were divided into an ABO compatible (ABOc) & XM positive (ABOc/XM+, n = 176) group and an ABOi & XM positive (ABOi/XM+, n = 87) group. The overall rejection rate one year after KT was significantly higher in the ABOi/XM+ group than in the ABOc/XM+ group (P < 0.01). A total of four mortalities occurred, all in the ABOi/XM+ patients (P < 0.01). There were no differences in surgical complications or the occurrence of infection-related complications, including BK virus nephropathy. Multivariate analysis indicated that female vs. male (odds ratio (OR), 2.27; P = 0.03), DSA class I (MFI/1000) (OR, 1.10; P = 0.03), DSA class II (MFI/1000) (OR, 1.10; P < 0.01), and ABOi & XM+ status (OR, 2.38; P < 0.01) were significant risk factors for acute rejection during the year after transplantation. Overall graft survival was inferior in ABOi/XM+ patients than in ABOc/XM+ patients (P = 0.02). ABO incompatibility in XM-positive KT patients was found to be a significant risk factor for the development of rejection within one year after transplantation as well as for long-term graft survival. The anti-blood group A, B and anti-HLA antibodies may show synergistic activity.

Original languageEnglish
Article number18229
JournalScientific reports
Volume9
Issue number1
DOIs
Publication statusPublished - 2019 Dec 1

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Blood Group Antigens
Kidney Transplantation
Cohort Studies
Odds Ratio
Antibodies
Graft Survival
Registries
Transplantation
BK Virus
Organ Transplantation
Korea
Anti-Idiotypic Antibodies
Multivariate Analysis
Databases
Mortality
Infection

ASJC Scopus subject areas

  • General

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Effect of simultaneous presence of anti-blood group A/B and -HLA antibodies on clinical outcomes in kidney transplantation across positive crossmatch : a nationwide cohort study. / the Korean Organ Transplantation Registry Study Group.

In: Scientific reports, Vol. 9, No. 1, 18229, 01.12.2019.

Research output: Contribution to journalArticle

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title = "Effect of simultaneous presence of anti-blood group A/B and -HLA antibodies on clinical outcomes in kidney transplantation across positive crossmatch: a nationwide cohort study",
abstract = "ABO-incompatible (ABOi) and positive crossmatch (XM) kidney transplantation (KT) have been considered immunologically challenging. The present study analyzed the clinical outcomes in XM positive KT based on ABO incompatibility. We used data from the Korea Organ Transplantation Registry, a nationwide database, and a single-center registry. A total of 263 patients with positive XM were divided into an ABO compatible (ABOc) & XM positive (ABOc/XM+, n = 176) group and an ABOi & XM positive (ABOi/XM+, n = 87) group. The overall rejection rate one year after KT was significantly higher in the ABOi/XM+ group than in the ABOc/XM+ group (P < 0.01). A total of four mortalities occurred, all in the ABOi/XM+ patients (P < 0.01). There were no differences in surgical complications or the occurrence of infection-related complications, including BK virus nephropathy. Multivariate analysis indicated that female vs. male (odds ratio (OR), 2.27; P = 0.03), DSA class I (MFI/1000) (OR, 1.10; P = 0.03), DSA class II (MFI/1000) (OR, 1.10; P < 0.01), and ABOi & XM+ status (OR, 2.38; P < 0.01) were significant risk factors for acute rejection during the year after transplantation. Overall graft survival was inferior in ABOi/XM+ patients than in ABOc/XM+ patients (P = 0.02). ABO incompatibility in XM-positive KT patients was found to be a significant risk factor for the development of rejection within one year after transplantation as well as for long-term graft survival. The anti-blood group A, B and anti-HLA antibodies may show synergistic activity.",
author = "{the Korean Organ Transplantation Registry Study Group} and Hyunwook Kwon and Kim, {Jee Yeon} and Kim, {Dong Hyun} and Youngmin Ko and Choi, {Ji Yoon} and Sung Shin and Jung, {Joo Hee} and Kim, {Young Hoon} and Han, {Duck Jong} and Curie Ahn and Chae, {Dong Wan} and Jaeseok Yang and Choi, {Bum Soon} and Jung, {Cheol Woong} and Kim, {Myung Soo} and Kwon, {Oh Jung} and Park, {Jae Berm} and Kim, {Yeong Hoon} and Choi, {Soo Jin Na} and Han, {Seung Yeup} and Lee, {Sang Ho} and Jeong, {Kyung Hwan} and Kim, {Seung Jung} and Jeon, {Jin Seok} and Park, {Yeon Ho} and Roh, {Young Nam} and Lee, {Jeong Joon} and Lee, {Kang Wook} and Han, {Seung Yeup} and Kim, {Chan Duck} and Park, {Jong Won} and Kim, {Joong Kyung} and Lee, {Dong Ryeol} and Lee, {Dong Won} and Seong, {Eun Young} and Kong, {Jin Min} and Cho, {Hong Rae} and Park, {Sung Kwang} and Lee, {Sam Yeol} and Park, {Jung Hwan}",
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AU - the Korean Organ Transplantation Registry Study Group

AU - Kwon, Hyunwook

AU - Kim, Jee Yeon

AU - Kim, Dong Hyun

AU - Ko, Youngmin

AU - Choi, Ji Yoon

AU - Shin, Sung

AU - Jung, Joo Hee

AU - Kim, Young Hoon

AU - Han, Duck Jong

AU - Ahn, Curie

AU - Chae, Dong Wan

AU - Yang, Jaeseok

AU - Choi, Bum Soon

AU - Jung, Cheol Woong

AU - Kim, Myung Soo

AU - Kwon, Oh Jung

AU - Park, Jae Berm

AU - Kim, Yeong Hoon

AU - Choi, Soo Jin Na

AU - Han, Seung Yeup

AU - Lee, Sang Ho

AU - Jeong, Kyung Hwan

AU - Kim, Seung Jung

AU - Jeon, Jin Seok

AU - Park, Yeon Ho

AU - Roh, Young Nam

AU - Lee, Jeong Joon

AU - Lee, Kang Wook

AU - Han, Seung Yeup

AU - Kim, Chan Duck

AU - Park, Jong Won

AU - Kim, Joong Kyung

AU - Lee, Dong Ryeol

AU - Lee, Dong Won

AU - Seong, Eun Young

AU - Kong, Jin Min

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N2 - ABO-incompatible (ABOi) and positive crossmatch (XM) kidney transplantation (KT) have been considered immunologically challenging. The present study analyzed the clinical outcomes in XM positive KT based on ABO incompatibility. We used data from the Korea Organ Transplantation Registry, a nationwide database, and a single-center registry. A total of 263 patients with positive XM were divided into an ABO compatible (ABOc) & XM positive (ABOc/XM+, n = 176) group and an ABOi & XM positive (ABOi/XM+, n = 87) group. The overall rejection rate one year after KT was significantly higher in the ABOi/XM+ group than in the ABOc/XM+ group (P < 0.01). A total of four mortalities occurred, all in the ABOi/XM+ patients (P < 0.01). There were no differences in surgical complications or the occurrence of infection-related complications, including BK virus nephropathy. Multivariate analysis indicated that female vs. male (odds ratio (OR), 2.27; P = 0.03), DSA class I (MFI/1000) (OR, 1.10; P = 0.03), DSA class II (MFI/1000) (OR, 1.10; P < 0.01), and ABOi & XM+ status (OR, 2.38; P < 0.01) were significant risk factors for acute rejection during the year after transplantation. Overall graft survival was inferior in ABOi/XM+ patients than in ABOc/XM+ patients (P = 0.02). ABO incompatibility in XM-positive KT patients was found to be a significant risk factor for the development of rejection within one year after transplantation as well as for long-term graft survival. The anti-blood group A, B and anti-HLA antibodies may show synergistic activity.

AB - ABO-incompatible (ABOi) and positive crossmatch (XM) kidney transplantation (KT) have been considered immunologically challenging. The present study analyzed the clinical outcomes in XM positive KT based on ABO incompatibility. We used data from the Korea Organ Transplantation Registry, a nationwide database, and a single-center registry. A total of 263 patients with positive XM were divided into an ABO compatible (ABOc) & XM positive (ABOc/XM+, n = 176) group and an ABOi & XM positive (ABOi/XM+, n = 87) group. The overall rejection rate one year after KT was significantly higher in the ABOi/XM+ group than in the ABOc/XM+ group (P < 0.01). A total of four mortalities occurred, all in the ABOi/XM+ patients (P < 0.01). There were no differences in surgical complications or the occurrence of infection-related complications, including BK virus nephropathy. Multivariate analysis indicated that female vs. male (odds ratio (OR), 2.27; P = 0.03), DSA class I (MFI/1000) (OR, 1.10; P = 0.03), DSA class II (MFI/1000) (OR, 1.10; P < 0.01), and ABOi & XM+ status (OR, 2.38; P < 0.01) were significant risk factors for acute rejection during the year after transplantation. Overall graft survival was inferior in ABOi/XM+ patients than in ABOc/XM+ patients (P = 0.02). ABO incompatibility in XM-positive KT patients was found to be a significant risk factor for the development of rejection within one year after transplantation as well as for long-term graft survival. The anti-blood group A, B and anti-HLA antibodies may show synergistic activity.

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