# The viability of ABO-incompatible kidney transplants: a single-center cohort in China

## TL;DR

This study shows that ABO-incompatible kidney transplants in China have similar short- to mid-term outcomes as compatible transplants, despite higher initial costs.

## Contribution

The study provides new evidence on the safety and feasibility of ABOi-LDKT in a Chinese population.

## Key findings

- ABOi-LDKT showed comparable 1- and 3-year patient and graft survival to ABOc-LDKT in the single-center cohort.
- Hospitalization costs were higher for ABOi-LDKT due to desensitization procedures.
- No significant differences were found in complications, infections, or acute rejection between the groups.

## Abstract

ABO-incompatible living donor kidney transplantation (ABOi-LDKT) offers a potential solution to organ shortages, but its safety and economic impact in China remain uncertain. This study evaluated short- to mid-term outcomes of ABOi-LDKT in a Chinese population by integrating evidence from a meta-analysis and a single-center cohort.

We performed a meta-analysis of 18 studies including 15,611 kidney transplant recipients to compare graft and patient survival between ABOi-LDKT and ABO-compatible LDKT (ABOc-LDKT). In parallel, we conducted a retrospective single-center cohort study of 41 ABOi-LDKT and 132 ABOc-LDKT recipients transplanted between 2021 and 2022. Outcomes included patient and graft survival, renal function, postoperative complications, infections, delayed graft function (DGF), acute rejection, and hospitalization costs.

The meta-analysis showed lower 1-year graft survival and 3-year patient survival in ABOi-LDKT than in ABOc-LDKT. In contrast, our single-center cohort demonstrated comparable 1- and 3-year patient and graft survival between groups. No significant differences were observed in surgical complications, infections, DGF, or acute rejection. ABOi-LDKT recipients showed better renal function at two weeks post-transplant, with no sustained differences thereafter. Hospitalization costs were higher in the ABOi-LDKT group, reflecting additional desensitization procedures.

In this Chinese single-center cohort, ABOi-LDKT achieved short- to mid-term clinical outcomes comparable to ABOc-LDKT despite higher upfront costs. When combined with contemporary desensitization protocols, ABOi-LDKT appears to be a safe and feasible strategy to expand access to living donor kidney transplantation in settings with severe organ shortages.