A Multicenter Cohort Study From India of ABO-Incompatible Kidney Transplantation in Post–COVID-19 Patients

• Published in: Transplantation proceedings 2022-12, Vol.54 (10), p.2652-2657
• Main Authors: Kute, Vivek, Ray, Deepak Shankar, Dalal, Sonal, Hegde, Umapati, Godara, Suraj, Pathak, Vivek, Bahadur, M.M., Khullar, Dinesh, Guleria, Sandeep, Vishwanath, S, Singhare, Ashay, Yadav, Dinesh, Bansal, Shyam Bihari, Chauhan, Sanshriti, Meshram, Hari Shankar
• Format: Article
• Language: English
• Subjects: ABO Blood-Group System; Adult; Blood Group Incompatibility; Cohort Studies; COVID-19 - epidemiology; Graft Rejection - epidemiology; Graft Survival; Humans; Kidney Transplantation - adverse effects; Living Donors; Middle Aged; Retrospective Studies; Rituximab; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2022.07.002

•There are no data on the procedure and outcomes of ABO-incompatible kidney transplant (ABOiKTx) among post–COVID-19 patients.•In this retrospective, multicentric cohort the ABO protocol and outcomes, in terms of biopsy-proven acute rejection (BPAR), graft loss, patient death, and infections were analysed. In our results of 38 ABOiKTx performed, no deviation from the standard ABO protocol was done, and BPAR, graft loss, and mortality were 13.1%, 2.6%, and 2.6% respectively.•Our report highlights that ABOiKTx in post–COVID-19 patients are successfully performed with no issues of post–COVID-19 recovery stage. There is a dearth of data regarding the consequences of ABO-incompatible kidney transplant (ABOiKTx) among post–COVID-19 candidates. The study was designed as a retrospective, multicentric cohort study across 11 sites in India, from August 2020 to December 2021. The data for ABOiKTx conducted for post–COVID-19 candidates were investigated. The primary outcome of biopsy-proven acute rejection was compared with the ABO protocol implemented through Kaplan-Meier analysis. The secondary outcomes were graft loss, patient survival, and infections. A total of 38 ABOiKTx with candidates of median (interquartile range) age of 38.5 (31.25-47.5) years were performed. Nineteen cases had mild COVID-19 severity, while 9 cases (23.6%) had an oxygen requirement. Six (15.7%) donors also were post–COVID-19. The most common ABO incompatibility reported was A to O in 14 (36.8%) pairs followed by B to O in 10 (26.3%) pairs. The maximum isoagglutinin titer cutoff was 1:2048 and 1:64 for baseline and pretransplant levels, respectively. The median time from COVID-19 infection to surgery was 130 (63.2-183) days. Biopsy-proven acute rejection, graft loss, and mortality were 13.1%, 2.6%, and 2.6%, respectively. The Breslow-Wilcoxon's P value in Kaplan-Meier plots were 0.57 and 0.93 for thymoglobulin-based induction and high dose rituximab-based regimen, respectively. The incidence of reinfection was 2.6%. Two (5.2%) urinary tract infections were reported. No cytomegalovirus or BK polyomavirus infection was reported. The median serum creatinine at 1 year of follow-up was 1.1 (0.8-1.3) mg/dL. Our report implies that ABOiKTx in post–COVID-19 candidates can be successfully performed with no major deviation from standard ABO protocol.