06 October 2020 : Original article
Acute Rejection and Infectious Complications in ABO- and HLA-Incompatible Kidney Transplantations
Youngmin Ko1BCDE, Jee Yeon Kim1BCDE, Sung-Han Kim2ADEF, Dong Hyun Kim1B, Seong Jun Lim1B, Sung Shin1CD, Young Hoon Kim1BCD, Joo Hee Jung1BC, Su-Kil Park3DE, Hyunwook Kwon1ABCDEF*, Duck Jong Han1ADFDOI: 10.12659/AOT.927420
Ann Transplant 2020; 25:e927420
Table 1 Demographics and baseline clinical characteristics.
| Variables | ABOc & HLAc (N=1190) | ABOc & HLAi* (N = 131) | ABOi & HLAc (N=358) | ABOi & HLAi* (N=53) | P-value |
|---|---|---|---|---|---|
| Age, years | 45.9±12.0 | 48.2±12.2 | 47.3±11.6 | 50.8±11.1 | 0.02c |
| BMI, kg/m | 25.0±7.5 | 22.3±3.5 | 23.5±9.1 | 21.5±2.4 | 0.93 |
| Female | 463 (38.9) | 98 (74.8) | 134 (37.4) | 32 (60.4) | <0.01 |
| Cause of ESRD | 0.30 | ||||
| Hypertension | 165 (13.9) | 19 (14.5) | 38 (10.6) | 8 (15.1) | |
| Diabetes mellitus | 282 (23.7) | 27 (20.6) | 106 (29.6) | 8 (15.1) | |
| GN | 146 (12.3) | 16 (12.2) | 38 (10.6) | 7 (13.2) | |
| IgA nephropathy | 160 (13.4) | 15 (11.5) | 58 (16.2) | 10 (18.9) | |
| FSGS | 21 (1.8) | 2 (1.5) | 11 (3.1) | 0 (0.0) | |
| PCKD | 39 (3.3) | 3 (2.3) | 11 (3.1) | 3 (5.7) | |
| Unknown | 267 (22.4) | 33 (25.2) | 65 (18.2) | 14 (26.4) | |
| Others | 110 (9.2) | 16 (12.2) | 31 (8.7) | 3 (5.7) | |
| Dialysis | <0.01 | ||||
| HD | 777 (65.3) | 96 (73.3) | 275 (76.8) | 42 (79.2) | |
| CAPD | 132 (11.1) | 14 (10.7) | 28 (7.8) | 3 (5.7) | |
| Pre-emptive | 280 (23.6) | 21 (16.0) | 55 (15.4) | 8 (15.1) | |
| Duration of dialysis, months | 20.9±37.9 | 23.0±37.2 | 20.2±33.2 | 24.5±36.4 | 0.80 |
| Previous transplant | 58 (4.8) | 21 (16.1) | 22 (6.1) | 13 (24.5) | <0.01 |
| Calcineurin inhibitor | 0.03 | ||||
| Tacrolimus | 815 (68.5) | 104 (79.4) | 260 (72.6) | 41 (77.4) | |
| Cyclosporin | 375 (31.5) | 27 (20.6) | 98 (27.4) | 12 (22.6) | |
| Rituximab dose, mg | – | 390±194 | 196±29 | 392±145 | <0.01,d |
| Pre-transplant PP, number | – | 5.5±4.6 | 3.0±1.5 | 6.4±5.5 | <0.01,0.04d |
| HLA-incompatible* | 0.18e | ||||
| CDC (+) | – | 15 (11.5) | – | 10 (18.9) | |
| FCXM (+) | – | 97 (74.0) | – | 32 (60.4) | |
| DSA MFI ≥5000 & FCXM (−) | – | 19 (14.5) | – | 11 (20.8) | |
| HLA-A,B,DR mismatch | 3.0±1.6 | 3.4±1.7 | 3.4±1.6 | 3.4±1.4 | 0.03<0.01a |
| PRA class I | 6.9±18.5 | 45.2±38.6 | 9.2±19.9 | 43.8±35.6 | <0.01,,,a |
| PRA class II | 7.9±19.8 | 35.6±39.4 | 10.0±21.5 | 48.3±38.8 | <0.01,,,,a |
| Maximal DSA MFI | 346±910 | 9367±4349 | 495±1067 | 7292±4193 | <0.01,,,,a |
| Categorical variables are presented as counts and percentages. Continuous variables are presented as means and standard deviations. ABOc – ABO-compatible; ABOi – ABO-incompatible; BMI – body mass index; ESRD – end-stage renal disease; GN – glomerulonephritis; FSGS – focal segmental glomerulosclerosis; PCKD – polycystic kidney disease; HD – hemodialysis; CAPD – continuous ambulatory peritoneal dialysis; PP – plasmapheresis; CDC – complement-dependent cytotoxicity; FCXM – flow-cytometric crossmatch; MFI – mean fluorescence intensity; HLA – human leukocyte antigen; PRA – panel reactive antibody; DSA – donor-specific antibody. * HLA-incompatible kidney transplantation was defined as CDC XM, FCXM-positive, and/or maximal DSA MFI ≥5000. a P-value between ABOc & HLAc group and ABOc & HLAi group; b P-value between the ABOc & HLAc group and the ABOi & HLAc group; c P-value between the ABOc & HLAc group and the ABOi & HLAi group; d P-value between the ABOc & HLAi group and the ABOi & HLAc group; e P-value between the ABOc & HLAi group and the ABOi & HLAi group; F P-value between the ABOi & HLAc group and the ABOi & HLAi group. | |||||