A Comparative Analysis of Live-Related ABO-Incompatible and ABO-Compatible Renal Transplantation Effect of Vitamin D Deficiency on Antibody-Mediated Rejection - A Retrospective Observational Study

• Published in: Indian journal of transplantation Vol. 15; no. 4; pp. 300 - 306
• Main Authors: Yachha, Monika, Sharma, Raj, Mehrotra, Sonia, Prasad, Narayan, Gupta, Amit, Bhadauria, Dharmendra, Kaul, Anupama
• Format: Journal Article
• Language: English
• Published: Medknow Publications and Media Pvt. Ltd 01.10.2021; Wolters Kluwer Medknow Publications
• Subjects: abo-incompatible kidney transplantation; Alfacalcidol; Antibodies; antibody-mediated rejection; Basiliximab; Calcifediol; Comparative analysis; Developing countries; Kidneys; plasmapheresis; Transplantation; Viral antibodies; Vitamin D; Vitamin D deficiency; India
• ISSN: 2212-0017; 2212-0025
• DOI: 10.4103/ijot.ijot_90_20

Background: ABO incompatible (ABOi) transplantation is a relatively newer option for renal transplant. Despite the encouraging results and the presence of organ shortage, it is still not routine in many developing countries. This can be attributed to the lack of experience, lack of technical infrastructure, and financial limitations. Objectives: Our study aimed to compare the outcomes of living-donor ABOi renal transplantation with matched recipients of ABO-compatible (ABOc) transplantation. We also assessed the impact of Vitamin D deficiency on posttransplant outcomes in terms of graft function and rejections in these groups. Methods: We retrospectively analyzed the results of 33 ABOi living-donor kidney transplants performed between January 2013 and June 2016 at our center. We compared patient and graft survival, acute rejection episodes, Vitamin D status, and graft function of the ABOi group with an equal number of matched live-related ABOc KTs done during the same time period. Results: The patient survival in both the groups was 97%; however, death-censored graft survival was 94% in the ABOi recipients versus 100% in ABOc group over a mean follow-up of 14–15 months, respectively. Graft function was overall better in the ABOc recipients, with statistical significance seen at 6 and 12 months posttransplant. We also observed a significantly higher incidence of acute antibody-mediated rejections (ABMRs) in the ABOi cohort, with 11 episodes of ABMR versus just 2 in the ABOc recipients ( P = 0.005). Vitamin D deficiency was associated with higher levels of anti-ABO antibody and increased development of ABMR due to anti-ABO antibodies ( P = 0.01). Conclusions: ABO incompatible transplantation is an option with excellent patient and graft survival; results almost comparable to the ABO compatible grafts. However, in our study, ABOi transplants were associated with higher risk of acute ABMR. These episodes were amenable to treatment, and thus, the overall graft survival had similar outcomes. Vitamin D deficiency was associated with increased ABMR in ABOi cohort of renal transplantation.