Long-term Follow-up of ABO-Incompatible Kidney Transplantation in Freiburg, Germany: A Single-Center Outcome Report

Transplant Proc. 2021 Apr;53(3):848-855. doi: 10.1016/j.transproceed.2020.09.001. Epub 2020 Oct 9.


Background: ABO-incompatible kidney transplantation (ABOi-KT) is an established way to enlarge the donor pool around the world. Comparability of long-term success and complications to ABO-compatible kidney transplantation (ABOc-KT) are still under debate.

Methods: We evaluated all patients with a living donor kidney transplantation performed between April 1, 2004, and March 31, 2019.

Results: A total of 137 ABOi-KT and 346 ABOc-KT were analyzed. We excluded 4 ABOi-KT recipients and 178 ABOc-KT recipients with cyclosporine A-based immunosuppression or without basiliximab induction. Three patients of the ABOi-KT cohort and 6 patients of the ABOc-KT cohort were lost to follow-up and therefore excluded. The patient characteristics were comparable except for the higher age of transplant recipients in the ABOc-KT cohort and longer follow-up of the ABOi-KT cohort. The mean estimated 15-year recipient survival was 89% in the ABOi-KT cohort and 91% in the ABOc-KT cohort (P = .39). Mean estimated graft survival was 71% in the ABOi-KT cohort and 87% in the ABOc-KT cohort (P = .68). The estimated glomerular filtration rate (Modification of Diet in Renal Disease) measured in the last follow-up was 51 mL/min/1.73 m2 in the ABOi-KT cohort and 50 mL/min/1.73 m2 in the ABOc-KT cohort (P = .36). The incidence for antibody-mediated rejection, T cell-mediated rejections, and infectious complications requiring hospitalization was not different between the cohorts. In the ABOi-KT cohort, we found significantly more lymphoceles and consequent surgical revision procedures.

Conclusions: At our center, ABOi-KT has as good long-term results as ABOc-KT in terms of patient survival, graft survival, and complications, with the exception of increased lymphocele formation.

MeSH terms

  • Adult
  • Blood Group Incompatibility / immunology
  • Blood Group Incompatibility / mortality*
  • Blood Group Incompatibility / surgery
  • Blood Grouping and Crossmatching
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Germany
  • Glomerular Filtration Rate
  • Graft Rejection / immunology
  • Graft Rejection / mortality*
  • Graft Survival / immunology
  • Humans
  • Immunosuppression Therapy / methods
  • Immunosuppression Therapy / mortality
  • Kidney Transplantation / methods
  • Kidney Transplantation / mortality*
  • Living Donors
  • Lymphocele / immunology
  • Lymphocele / mortality
  • Male
  • Middle Aged
  • Postoperative Complications / immunology
  • Postoperative Complications / mortality*
  • Renal Insufficiency, Chronic / immunology
  • Renal Insufficiency, Chronic / surgery*
  • Survival Rate
  • Treatment Outcome