Complications, resource utilization, and cost of ABO-incompatible living donor kidney transplantation

Transplantation. 2006 Jul 27;82(2):155-63. doi: 10.1097/


Background: The transplantation of living donor renal allografts across blood group barriers requires protocols to reduce and maintain anti-blood group antibody at safe levels. These protocols lead to an increase in resource utilization and cost of transplantation and may result in increased complications.

Methods: In this retrospective study, we compared 40 ABO-incompatible to 77 matching ABO-compatible living donor renal allografts with respect to complications, resource utilization, and cost from day -14 to 90 days after transplantation.

Results: Overall, surgery-related complications and resource utilization were increased in the ABO-incompatible group, primarily due to the desensitization protocol and antibody-mediated rejection. In the absence of rejection, the mean number of complications was similar for both groups. ABO-incompatible kidney transplantation was approximately 38,000 US dollars more expensive than ABO-compatible transplants, but was cost effective when compared to maintaining the patient on dialysis while waiting for a blood group compatible deceased donor kidney. Actuarial graft and patient survival was similar in the two groups.

Conclusions: We conclude that ABO-incompatible living donor kidney transplantation is a viable option for patients whose only donor is blood group incompatible despite the additional resource utilization and cost of therapy.

MeSH terms

  • ABO Blood-Group System*
  • Adult
  • Blood Group Incompatibility* / economics
  • Cost of Illness
  • Diabetes Mellitus / epidemiology
  • Diabetic Nephropathies / surgery
  • Female
  • Graft Rejection / drug therapy
  • Graft Rejection / epidemiology
  • Graft Survival
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / economics*
  • Kidney Transplantation / immunology*
  • Kidney Transplantation / mortality
  • Living Donors*
  • Male
  • Middle Aged
  • Minnesota
  • Postoperative Complications / epidemiology
  • Resource Allocation*
  • Retrospective Studies
  • Survival Analysis


  • ABO Blood-Group System
  • Immunosuppressive Agents