Clinical outcomes of ABO- and HLA-incompatible kidney transplantation: a nationwide cohort study

Transpl Int. 2017 Dec;30(12):1215-1225. doi: 10.1111/tri.12979. Epub 2017 Jul 6.


This was a nationwide cohort study to investigate the impact of anti-A/B and donor-specific anti-HLA (HLA-DSA) antibodies on the clinical outcomes in kidney transplant recipients (KTRs). We classified a total of 1964 KTRs into four groups: transplants from ABO-incompatible donors (ABOi, n = 248); transplants in recipients with HLA-DSA (HLAi, n = 144); transplants from combined ABOi and HLAi donors (ABOi + HLAi, n = 31); and a control group for whom neither ABOi nor HLAi was applicable (CONT, n = 1541). We compared the incidence of biopsy-proven acute rejection (BPAR), allograft and patient survival rates. The incidence of BPAR was higher in the HLAi and ABOi + HLAi groups relative to the CONT group; in contrast, it was not higher in the ABOi group. Death-censored graft survival rates did not differ across the four groups. However, relative to the CONT group, patient survival rate was reduced in the ABOi and ABOi + HLAi groups, and with infection being the most common cause of death. Further, multivariable analysis revealed that desensitization therapy because of ABOi or HLAi was independent risk factors for patient mortality. HLAi was a more important risk factor for BPAR compared with ABOi. However, pretransplant desensitization therapy for either ABOi or HLAi significantly increased the risk of infection-related mortality.

Keywords: ABO incompatibility; kidney transplantation; sensitization.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • ABO Blood-Group System / immunology*
  • Adult
  • Analysis of Variance
  • Blood Group Incompatibility / complications*
  • Cohort Studies
  • Desensitization, Immunologic / methods*
  • Female
  • Graft Rejection
  • Graft Survival
  • HLA Antigens / immunology*
  • Humans
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / methods
  • Kidney Transplantation / mortality
  • Living Donors
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Republic of Korea
  • Risk Assessment
  • Survival Analysis
  • Transplantation Immunology / physiology
  • Treatment Outcome


  • ABO Blood-Group System
  • HLA Antigens