Early clinical complications after ABO-incompatible live-donor kidney transplantation: a national study of Medicare-insured recipients.
Early clinical complications after ABO-incompatible live-donor kidney transplantation: a national study of Medicare-insured recipients.
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DOI：
10.1097/tp.0000000000000029
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发表时间：
2014-07-15
期刊：
影响因子：
6.2
通讯作者：
Segev DL
中科院分区：
文献类型：
--
作者：
Lentine KL;Axelrod D;Klein C;Simpkins C;Xiao H;Schnitzler MA;Tuttle-Newhall JE;Dharnidharka VR;Brennan DC;Segev DL
Descriptions of the sequelae of ABO incompatible (ABOi) kidney transplantation are limited to single-center reports which may lack power to detect important effects. We examined United States 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 2000–2007, 119 non-donor-A2 ABOi transplants were identified. A2 incompatible (A2i, n=35) transplants were categorized separately. Infection and hemorrhage events were identified by diagnosis codes on billing claims. Associations of ABOi with complications were assessed by multivariate Cox regression. Recipients of ABOi transplants had 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)/pyelonephritis (24.5% vs 15.3%) in the first 90 days compared with ABO compatible (ABOc) recipients. In adjusted models, ABOi was associated with twice the risk of pneumonia (aHR 2.10, 95%CI 1.08-4.09) and 55% higher risk of UTIs/pyelonephritis (aHR 1.55, 95% CI 1.05-2.29) in the first 90 post-transplant days, and 3.5-times the relative risk of wound infections in days 91-365 (aHR 3.55, 95% CI 1.92–6.57). The adjusted risk of hemorrhage was higher in ABOi recipients (aHR 1.85, 95%CI 1.12-3.05), 19% of whom underwent splenectomy before transplantation. A2i transplantation was associated only with early risk of UTIs/pyelonephritis. 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.
