Complications, resource utilization, and cost of ABO-incompatible living donor kidney transplantation.
BACKGROUND
The transplantation of living donor renal allografts across blood group barriers requires protocols to reduce and maintain anti-blood group antibody at safe levels. These protocols lead to an increase in resource utilization and cost of transplantation and may result in increased complications.


METHODS
In this retrospective study, we compared 40 ABO-incompatible to 77 matching ABO-compatible living donor renal allografts with respect to complications, resource utilization, and cost from day -14 to 90 days after transplantation.


RESULTS
Overall, surgery-related complications and resource utilization were increased in the ABO-incompatible group, primarily due to the desensitization protocol and antibody-mediated rejection. In the absence of rejection, the mean number of complications was similar for both groups. ABO-incompatible kidney transplantation was approximately 38,000 US dollars more expensive than ABO-compatible transplants, but was cost effective when compared to maintaining the patient on dialysis while waiting for a blood group compatible deceased donor kidney. Actuarial graft and patient survival was similar in the two groups.


CONCLUSIONS
We conclude that ABO-incompatible living donor kidney transplantation is a viable option for patients whose only donor is blood group incompatible despite the additional resource utilization and cost of therapy.
Schwartz
Jason
J
Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Stegall
Mark D
MD
Kremers
Walter K
WK
Gloor
James
J
D000017:ABO Blood-Group System; D000328:Adult; D001787:Blood Group Incompatibility / Q000191:economics; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects / Q000191:economics* / Q000276:immunology* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011183:Postoperative Complications / Q000453:epidemiology; D040841:Resource Allocation; D012189:Retrospective Studies; D016019:Survival Analysis
D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents