Clinical outcomes after ABO-incompatible renal transplantation: a systematic review and meta-analysis

This study is registered with PROSPERO, number CRD42018094550.Findings1264 studies were screened and 40 studies including 49 patient groups were identified. 65 063 patients were eligible for analysis, 7098 of whom had undergone ABOi-rTx. Compared with ABOc-rTx, ABOi-rTx was associated with significantly higher 1-year mortality (odds ratio [OR] 2·17 [95% CI 1·63–2·90], p<0·0001; I2=37%), 3 years (OR 1·89 [1·46–2·45], p<0·0001; I2=29%), and 5 years (OR 1·47 [1·08–2·00], p=0·010; I2=68%) following transplantation. Death-censored graft survival was lower with ABOi-rTx than with ABOc-rTx at 1 year (OR 2·52 [1·80–3·54], p<0·0001; I2=61%) and 3 years (OR 1·59 [1·15–2·18], p=0·0040; I2=58%) only. Graft losses were equivalent to that of ABOc-rTx after 5 years and patient survival after 8 years. No publication bias was detected and the results were robust to trial sequential analysis until 5 years after transplantation; thereafter, data became futile or inconclusive.InterpretationDespite progress in desensitisation protocols and optimisation of ABOi-rTx procedures, excess mortality and loss of kidney grafts was found compared with ABOc-rTx within the first 3 years after transplantation. Only long-term outcomes after 5 years yielded equivalent survival rates and organ function. Awareness of the increased risks of infection, organ rejection, and bleeding could improve care of patients and promote efforts towards paired kidney exchange programme...
Source: The Lancet - Category: General Medicine Source Type: research