Kidney Week

Abstract: TH-PO830

Human Leukocyte Antigen (HLA)-Incompatible Kidney Transplantation Shows Similar Outcomes Compared with HLA-Compatible Kidney Transplantation after Early Rejection

Session Information

• Transplantation: Clinical - 2
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Oh, Youn sik, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Youn sik Oh, MD

• Min, Ji Won, The Catholic University of Korea Seoul St Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)

Ji Won Min, MD, PhD

• Lee, Sik, Jeonbuk National University Hospital, Jeonju, Jeollabuk-do , Korea (the Republic of)

Sik Lee, MD, PhD

• Yang, Jaeseok, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)

Jaeseok Yang, MD, PhD

• Kim, Myoung soo, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)

Myoung soo Kim, MD, PhD

• Kim, Mingyu, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Mingyu Kim

• Lim, Jeong-Hoon, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Jeong-Hoon Lim, MD, PhD

• Jung, Hee-Yeon, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Hee-Yeon Jung, MD, PhD

• Park, Sun-Hee, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Sun-Hee Park, MD, PhD

• Kim, Chan-Duck, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Chan-Duck Kim, MD, PhD

• Kim, Yong-Lim, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Yong-Lim Kim, MD, PhD

• Cho, Jang-Hee, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Jang-Hee Cho, MD, PhD

Group or Team Name

• KOTRY Study Group.

Background

HLA-incompatible (HLA-i) kidney transplantation (KT) constitutes a high-risk group with an increased risk of rejection and graft failure. We investigated the differences in short- and long-term outcomes of HLA-i KT compared to HLA-compatible (HLA-c) KT.

Methods

Patients with living donor KT were enrolled from a prospective nationwide cohort in Korea. HLA-i KT was defined as a desensitized transplantation with complement-dependent cytotoxicity (CDC) or flow-cytometric (FCM) crossmatch positivity. The primary outcome was a composite of acute rejection, graft failure, and patient death. The association between acute rejection and HLA types was analyzed. The trough levels of tacrolimus compared between HLA-i and HLA-c KT groups.

Results

A total of 3692 KT recipients were enrolled and 466 (12.6%) patients received HLA-i KT. Kaplan-Meier curve revealed that HLA-i KT showed higher acute rejection, graft failure, and the composite than HLA-c KT (P<0.05). The HLA-i group is associated with a higher risk of the composite (adjusted HR [aHR] 1.57; 95% CI 1.34-1.79; P<0.001) (Table 1) and acute rejection (aHR 1.56; 95% CI 1.37-2.88; P<0.001)(Table 2) than the HLA-c group during the 1st year after KT. However, 1 year after KT, all the transplant outcomes did not differ between the two groups. Logistic regression analysis showed that antibodies against HLA-DR were significantly associated with an increased risk of acute rejection (OR 1.93; 95% CI 1.14-3.28; P=0.015). Tacrolimus trough levels of the HLA-i and HLA-c groups showed no difference at 1 year after KT (6.3±2.2 vs. 6.4±2.3 ng/mL, respectively) and thereafter.

Conclusion

HLA-i KT showed worse transplant outcomes until 1 year after transplantation. However, HLA-i KT after the early period had non-inferior graft and patient survival results compared to HLA-c KT.

Funding

• Government Support – Non-U.S.