Infection Risk in the First Year After ABO-incompatible Kidney Transplantation: A Nationwide Prospective Cohort Study.

Abstract

BACKGROUND:

ABO-incompatible (ABOi) kidney transplantation (KT) expands the kidney donor pool and may help to overcome organ shortage. Nonetheless, concerns about infectious complications associated with ABOi-KT have been raised.

METHODS:

In a nationwide cohort (Swiss Transplant Cohort Study), we compared the risk for infectious complications among ABOi and ABO-compatible (ABOc) renal transplant recipients. Infections needed to fulfill rigorous, prespecified criteria to be classified as clinically relevant. Unadjusted and adjusted competing risk regression models were used to compare the time to the first clinically relevant infection among ABOi-KT and ABOc-KT recipients. Inverse probability weighted generalized mixed-effects Poisson regression was used to estimate incidence rate ratios for infection.

RESULTS:

We included 757 living-donor KT recipients (639 ABOc; 118 ABOi) and identified 717 infection episodes. The spectrum of causative pathogens and the anatomical sites affected by infections were similar between ABOi-KT and ABOc-KT recipients. There was no significant difference in time to first posttransplant infection between ABOi-KT and ABOc-KT recipients (subhazard ratio, 1.24; 95% confidence interval [CI], 0.93-1.66; P = 0.142). At 1 y, the crude infection rate was 1.11 (95% CI, 0.93-1.33) episodes per patient-year for ABOi patients and 0.94 (95% CI, 0.86-1.01) for ABOc-KT recipients. Inverse probability weighted infection rates were similar between groups (adjusted incidence rate ratio, 1.12; 95% CI, 0.83-1.52; P = 0.461).

CONCLUSIONS:

The burden of infections during the first year posttransplant was high but not relevantly different in ABOi-KT and ABOc-KT recipients. Our results highlight that concerns regarding infectious complications should not affect the implementation of ABOi-KT programs.

• Authors: Cédric Hirzel, Lea Projer, Andrew Atkinson, Bernard Surial, Nicolas J Mueller, Oriol Manuel, Matteo Mombelli, Christian van Delden, Hans H Hirsch, Katia Boggian, Laura N Walti, Daniel Sidler, Karine Hadaya, Michael Dickenmann, Thomas F Müller, Isabelle Binet, Déla Golshayan, Uyen Huynh-Do, Swiss Transplant Cohort Study (STCS)
• Journal: Transplantation (Transplantation) Vol. 106 Issue 9 Pg. 1875-1883 (09 01 2022) ISSN: 1534-6080 [Electronic] United States
• PMID: 35389968 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

Chemical References

• ABO Blood-Group System

Topics

• ABO Blood-Group System
• Anemia, Hemolytic, Autoimmune
• Blood Group Incompatibility
• Cohort Studies
• Graft Rejection (epidemiology)
• Graft Survival
• Humans
• Infections (epidemiology, etiology)
• Kidney Transplantation (adverse effects, methods)
• Living Donors
• Prospective Studies