Journal article
Early Clinical Complications After ABO-Incompatible Live-Donor Kidney Transplantation: A National Study of Medicare-Insured Recipients
Transplantation, Vol.98(1), pp.54-65
07/15/2014
DOI: 10.1097/TP.0000000000000029
PMCID: PMC4411309
PMID: 24978035
Abstract
Background. Descriptions of the sequelae of ABO-incompatible (ABOi) kidney transplantation are limited to single-center reports, which may lack power to detect important effects.
Methods. We examined U. S. Renal Data System registry data to study associations of ABOi live-donor kidney transplantation with clinical complications in a national cohort. Among 14,041 Medicare-insured transplants in 2000 to 2007, 119 non-donor-A2 ABOi transplants were identified. A2-incompatible (n=35) transplants were categorized separately. Infection and hemorrhage events were identified by diagnosis codes on billing claims. Associations of ABO incompatibility with complications were assessed by multivariate Cox regression.
Results. Recipients of ABOi transplants experienced significantly (P<0.05) higher incidence of wound infections (12.7% vs. 7.3%), pneumonia (7.6% vs. 3.8%), and urinary tract infections (UTIs) or pyelonephritis (24.5% vs. 15.3%) in the first 90 days compared with ABO-compatible recipients. In adjusted models, ABO incompatibility was associated with twice the risk of pneumonia (adjusted hazard ratio [aHR], 2.22; 95% confidence interval [CI], 1.14-4.33) and 56% higher risk of UTIs or pyelonephritis (aHR, 1.56; 95% CI, 1.05-2.30) in the first 90 posttransplantation days, and 3.5 times the relative risk of wound infections in days 91 to 365 (aHR, 3.55; 95% CI, 1.92-6.57). ABOi recipients, 19% of whom underwent pre- or peritransplant splenectomy, experienced twice the adjusted risk of early hemorrhage (aHR, 1.96; 95% CI, 1.19-3.24). A2-incompatible transplantation was associated only with early risk of UTIs or pyelonephritis.
Conclusion. ABOi transplantation offers patients with potential live donors an additional transplant option but with higher risks of infectious and hemorrhagic complications. Awareness of these complications may help improve protocols for the management of ABOi transplantation.
Details
- Title: Subtitle
- Early Clinical Complications After ABO-Incompatible Live-Donor Kidney Transplantation: A National Study of Medicare-Insured Recipients
- Creators
- Krista L. Lentine - Saint Louis UniversityDavid Axelrod - Dartmouth CollegeChristina Klein - Washington University in St. LouisChristopher Simpkins - Dartmouth CollegeHuiling Xiao - Saint Louis UniversityMark A. Schnitzler - Saint Louis UniversityJanet E. Tuttle-Newhall - Saint Louis UniversityVikas R. Dharnidharka - Washington University in St. LouisDaniel C. Brennan - Washington University in St. LouisDorry L. Segev - Washington University in St. Louis
- Resource Type
- Journal article
- Publication Details
- Transplantation, Vol.98(1), pp.54-65
- DOI
- 10.1097/TP.0000000000000029
- PMID
- 24978035
- PMCID
- PMC4411309
- NLM abbreviation
- Transplantation
- ISSN
- 0041-1337
- eISSN
- 1534-6080
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 12
- Grant note
- R01-DK098431 / National Institutes of Health (NIH); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA R01DK098431 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
- Language
- English
- Date published
- 07/15/2014
- Academic Unit
- Surgery
- Record Identifier
- 9984322926802771
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