Abstract：
BACKGROUND: There is no robust evidence-based data for ABO-incompatible kidney transplantation (ABOiKT) from emerging countries.
METHODS: Data from 1759 living donor ABOiKT and 33 157 ABO-compatible kidney transplantations (ABOcKT) performed in India between March 5, 2011, and July 2, 2022, were included in this retrospective, multicenter (n = 25) study. The primary outcomes included management protocols, mortality, graft loss, and biopsy-proven acute rejection (BPAR).
RESULTS: Protocol included rituximab 100 (232 [13.18%]), 200 (877 [49.85%]), and 500 mg (569 [32.34%]); immunoadsorption (IA) (145 [8.24%]), IVIG (663 [37.69%]), and no induction 200 (11.37%). Mortality, graft loss, and BPAR were reported in 167 (9.49%), 136 (7.73%), and 228 (12.96%) patients, respectively, over a median follow-up of 36.3 mo. In cox proportional hazard model, mortality was higher with IA (hazard ratio [HR]: 2.53 [1.62-3.97]; P < 0.001), BPAR (HR: 1.83 [1.25-2.69]; P = 0.0020), and graft loss (HR: 1.66 [1.05-2.64]; P = 0.0310); improved graft survival was associated with IVIG (HR: 0.44 [0.26-0.72]; P = 0.0010); higher BPAR was reported with conventional tube method (HR: 3.22 [1.9-5.46]; P < 0.0001) and IA use (HR: 2 [1.37-2.92]; P < 0.0001), whereas lower BPAR was reported in the prepandemic era (HR: 0.61 [0.43-0.88]; P = 0.008). Primary outcomes were not associated with rituximab dosing or high preconditioning/presurgery anti-A/anti-B titers. Incidence of overall infection 306 (17.39%), cytomegalovirus 66 (3.75%), and BK virus polyoma virus 20 (1.13%) was low. In unmatched univariate analysis, the outcomes between ABOiKT and ABOcKT were comparable.
CONCLUSIONS: Our largest multicenter study on ABOiKT provides insights into various protocols and management strategies with results comparable to those of ABOcKT.
METHODS: Data from 1759 living donor ABOiKT and 33 157 ABO-compatible kidney transplantations (ABOcKT) performed in India between March 5, 2011, and July 2, 2022, were included in this retrospective, multicenter (n = 25) study. The primary outcomes included management protocols, mortality, graft loss, and biopsy-proven acute rejection (BPAR).
RESULTS: Protocol included rituximab 100 (232 [13.18%]), 200 (877 [49.85%]), and 500 mg (569 [32.34%]); immunoadsorption (IA) (145 [8.24%]), IVIG (663 [37.69%]), and no induction 200 (11.37%). Mortality, graft loss, and BPAR were reported in 167 (9.49%), 136 (7.73%), and 228 (12.96%) patients, respectively, over a median follow-up of 36.3 mo. In cox proportional hazard model, mortality was higher with IA (hazard ratio [HR]: 2.53 [1.62-3.97]; P < 0.001), BPAR (HR: 1.83 [1.25-2.69]; P = 0.0020), and graft loss (HR: 1.66 [1.05-2.64]; P = 0.0310); improved graft survival was associated with IVIG (HR: 0.44 [0.26-0.72]; P = 0.0010); higher BPAR was reported with conventional tube method (HR: 3.22 [1.9-5.46]; P < 0.0001) and IA use (HR: 2 [1.37-2.92]; P < 0.0001), whereas lower BPAR was reported in the prepandemic era (HR: 0.61 [0.43-0.88]; P = 0.008). Primary outcomes were not associated with rituximab dosing or high preconditioning/presurgery anti-A/anti-B titers. Incidence of overall infection 306 (17.39%), cytomegalovirus 66 (3.75%), and BK virus polyoma virus 20 (1.13%) was low. In unmatched univariate analysis, the outcomes between ABOiKT and ABOcKT were comparable.
CONCLUSIONS: Our largest multicenter study on ABOiKT provides insights into various protocols and management strategies with results comparable to those of ABOcKT.
摘要：
背景：对于新兴国家的ABO不相容肾移植（ABOiKT），尚无可靠的循证数据。
方法：2011年3月5日至2022年7月2日在印度进行的1759例活体供者ABOiKT和33157例ABO相容性肾移植（ABOcKT）的数据被纳入本回顾性研究，多中心（n=25）研究。主要结果包括管理协议，死亡率,移植物丢失，和活检证实的急性排斥反应（BPAR）。
结果：方案包括利妥昔单抗100（232[13.18%]），200（877[49.85%]），和500毫克（569[32.34%]）；免疫吸附（IA）（145[8.24%]），IVIG（663[37.69%]），无诱导200（11.37%）。死亡率,移植物丢失，和BPAR在167（9.49%）中报告，136（7.73%），和228名(12.96%)患者，分别,中位随访时间为36.3个月。在Cox比例风险模型中，IA组死亡率较高(危险比[HR]:2.53[1.62-3.97];P<0.001),BPAR（HR：1.83[1.25-2.69]；P=0.0020），和移植物损失（HR：1.66[1.05-2.64];P=0.0310）；提高移植物存活率与IVIG相关（HR：0.44[0.26-0.72]；P=0.0010）；常规管法（HR：3.22[1.9-5.46]；P<0.0001）和IA使用（HR：2[1.37-2.92]；P<0.0001），而BPAR较低的病例出现在疾病前期(HR:0.61[0.43-0.88];P=0.008).主要结局与利妥昔单抗给药或高预处理/预处理前抗A/抗B滴度无关。总感染发生率306（17.39%），巨细胞病毒66（3.75%），BK病毒多瘤病毒20型(1.13%)较低。在不匹配的单变量分析中，ABOiKT和ABOcKT之间的结局具有可比性.
结论：我们关于ABOiKT的最大多中心研究提供了对各种方案和管理策略的见解，其结果与ABOcKT相当。
方法：2011年3月5日至2022年7月2日在印度进行的1759例活体供者ABOiKT和33157例ABO相容性肾移植（ABOcKT）的数据被纳入本回顾性研究，多中心（n=25）研究。主要结果包括管理协议，死亡率,移植物丢失，和活检证实的急性排斥反应（BPAR）。
结果：方案包括利妥昔单抗100（232[13.18%]），200（877[49.85%]），和500毫克（569[32.34%]）；免疫吸附（IA）（145[8.24%]），IVIG（663[37.69%]），无诱导200（11.37%）。死亡率,移植物丢失，和BPAR在167（9.49%）中报告，136（7.73%），和228名(12.96%)患者，分别,中位随访时间为36.3个月。在Cox比例风险模型中，IA组死亡率较高(危险比[HR]:2.53[1.62-3.97];P<0.001),BPAR（HR：1.83[1.25-2.69]；P=0.0020），和移植物损失（HR：1.66[1.05-2.64];P=0.0310）；提高移植物存活率与IVIG相关（HR：0.44[0.26-0.72]；P=0.0010）；常规管法（HR：3.22[1.9-5.46]；P<0.0001）和IA使用（HR：2[1.37-2.92]；P<0.0001），而BPAR较低的病例出现在疾病前期(HR:0.61[0.43-0.88];P=0.008).主要结局与利妥昔单抗给药或高预处理/预处理前抗A/抗B滴度无关。总感染发生率306（17.39%），巨细胞病毒66（3.75%），BK病毒多瘤病毒20型(1.13%)较低。在不匹配的单变量分析中，ABOiKT和ABOcKT之间的结局具有可比性.
结论：我们关于ABOiKT的最大多中心研究提供了对各种方案和管理策略的见解，其结果与ABOcKT相当。
