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Abstract ABO-incompatible (ABOi) and human leukocyte antigen (HLA)-incompatible (HLAi) kidney transplantations are known as immunological high-risk transplantation. Patients with incompatible living donors have to choose either undergoing desensitization and then transplantation or waiting for deceased donor kidney transplantation (DDKT). Studies on the outcome of ABOi and HLAi living donor kidney transplantations (LDKTs) compared to waiting for and receiving DDKT outside the United States and European countries remain scarce. This single-center retrospective study was conducted in patients who underwent ABOi, HLAi, and DDKT between January 2008 and November 2021. The patient survival rate was 97.7%, 92.5%, and 82.6% at 5, 10, and 15 years, respectively, in the DDKT group compared to 96.8% at 5 and 10 years in the ABOi group (P = 0.84) and 94.8% at 5 years in the HLAi group (P = 0.91). The death-censored graft survival was 95.6%, 83.1%, and 63.8% at 5, 10, and 15 years in the DDKT group, as compared to 90.3% at 5 and 10 years in the ABOi group (P = 0.73) and 92.1% at 5 years in the HLAi group (P = 0.53). Antibody-mediated rejection occurred significantly higher in the HLAi group with a hazard ratio of 2.77 (95% confidence interval: 1.31–5.88; P = 0.008) compared to the DDKT group. ABOi and HLAi KT did not increase rates of BK and cytomegalovirus (CMV) infection compared to DDKT. In summary, ABOi and HLAi transplant recipients had comparable patient, graft survival, and CMV and BK infections to DDKT. Our study emphasizes the usefulness of ABOi and HLAi LDKT to reduce patients’ waiting time and improve their quality of life.
Banjongjit et al. (Wed,) studied this question.