Long-Term Effect of Human Leukocyte Antigen (HLA) Sensitization on Patient and Graft Outcomes in ABO-Incompatible Living-Donor Kidney Transplantation

Background: ABOi KT outcomes study showed comparable long-term outcomes with ABO-compatible (ABOc); however, data is limited on effects of HLA sensitization in ABOi KT recipients. We studied impact of HLA sensitization on long term graft and patient survival following ABOi KT. Methods: The prospective study included ABOi KT (≥12 years) performed between Jan 2014 and Dec 2023. Desensitization involved rituximab, plasmapheresis, and IVIg to achieve anti-ABO titers ≤1:8. Induction (basiliximab or ATG) was risk-based. Demographics, immunological risk, desensitization, immunosuppression, BPAR and infection outcomes, with and without HLA sensitization were analyzed. Outcomes parameters BPAR, patient/graft survival at 1, 3, 5, and 10 years and serious infections requiring hospitalization(SIRH) were compared between HLA sensitized and non-sensitized ABOi KT . Results: Among 184 ABOi KT;74 HLA-sensitized with donor specific antibodies, and 110 non-HLA-sensitized. Sensitized patients had more repeat transplants (13.5% vs 0.9%, p<0.001) and higher DSA positivity (Class I: 27% vs 5.5%; Class II: 82.4% vs. 10%, both p=0.001) and higher ATG induction in sensitized patients (28.4% vs 11.8% p=0.005). BPAR, immediate and delayed graft function were similar (Figure 1). SIRH were also similar (31.1% vs. 43.6%, p=0.080). Five and 10 year patient and graft survival were similar (88.6% vs. 83%, p=0.39; 85.7% vs. 80% p=0.23) Figure 2. Conclusion: There were no difference in rejection, graft, or patient survival between HLA-sensitized and non-sensitized groups. Ten-year graft survival were similar between two groups. Funding: Government Support – Non-U.S.Outcomes between the HLA sensitised and nonsensitised patients with ABOi KTKM graft survival of ABOi KT with and without HLA sensitisation