ABO-incompatible kidney transplantation in perspective of deceased donor transplantation and induction strategies: a propensity-matched analysis

A.E. de Weerd*, J.A.J.G. van den Brand, H. Bouwsma, A.P.J. de Vries, I.M.M. Dooper, J.S.F. Sanders, M.H.L. Christiaans, F.E. van Reekum, A.D. van Zuilen, F.J. Bemelman, A.S. Nurmohamed, M. van Agteren, M.G.H. Betjes, M.F.C. de Jong, M.C. Baas

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Kidney transplant candidates are blood group incompatible with roughly one out of three potential living donors. We compared outcomes after ABO-incompatible (ABOi) kidney transplantation with matched ABO-compatible (ABOc) living and deceased donor transplantation and analyzed different induction regimens. We performed a retrospective study with propensity matching and compared patient and death-censored graft survival after ABOi versus ABOc living donor and deceased donor kidney transplantation in a nationwide registry from 2006 till 2019. 296 ABOi were compared with 1184 center and propensity-matched ABOc living donor and 1184 deceased donor recipients (matching: recipient age, sex, blood group, and PRA). Patient survival was better compared with deceased donor [hazard ratio (HR) for death of HR 0.69 (0.49-0.96)] and non-significantly different from ABOc living donor recipients [HR 1.28 (0.90-1.81)]. Rate of graft failure was higher compared with ABOc living donor transplantation [HR 2.63 (1.72-4.01)]. Rejection occurred in 47% of 140 rituximab versus 22% of 50 rituximab/basiliximab, and 4% of 92 alemtuzumab-treated recipients (P < 0.001). ABOi kidney transplantation is superior to deceased donor transplantation. Rejection rate and graft failure are higher compared with matched ABOc living donor transplantation, underscoring the need for further studies into risk stratification and induction therapy [NTR7587, ].
Original languageEnglish
Pages (from-to)2706-2719
Number of pages14
JournalTransplant International
Issue number12
Early online date11 Nov 2021
Publication statusPublished - Dec 2021


  • ABO-incompatible kidney transplantation
  • alemtuzumab
  • deceased donor transplantation
  • living donor transplantation
  • patient and graft survival
  • rejection


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