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Impact of ABO-incompatible living donor kidney transplantation on patient survival

Massie AB, et al. Am J Kidney Dis. 2020 Nov;76(5):616-623.


  • ABO incompatible (ABOi) living donor kidney transplant (LDKT) was developed to accommodate the growing organ shortage

  • As ABOi LDKT is associated with increased risks and higher costs, this study is important to understand whether ABOi LDKT actually confers a survival benefit compared to waiting for an ABO compatible (ABOc) LDKT or deceased donor kidney transplant (DDKT)


A retrospective cohort study of adults in the Scientific Registry of Transplant Recipients was conducted to evaluate the patient survival difference between ABOi LDKTs and those waiting for an ABOc LDKT or an ABOc DDKT

ABOi LDKT remains a viable treatment option for patients with a willing but incompatible living kidney donor

Study design

The study population was 245,966 consisted of adult first-time kidney waitlist registrants who were ever active on the deceased donor kidney waitlist in the United States, using SRTR data. There were 808 ABOi LDKT recipients and 2,423 matched controls from among 245,158 adult first-time kidney-only waitlist registrants who did not receive an ABOi LDKT and who remained on the waitlist or received either an ABOc LDKT or an ABOc DDKT between 2002 to 2017

Key highlights


  • In this national study, patients who received ABOi LDKTs had higher survival at 5 and 10 years (89.9% and 75.4%, respectively) than similar patients who remained on the waitlist or received ABOc LDKTs or DDKTs (81.9% and 68.4%, respectively)
  • ABOi LDKT was associated with survival benefit even in sensitivity analyses restricted to centers with active KPD programs
  • Transplant candidates who receive an ABOi LDKT and survive more than 180 days post transplantation experience a long-term survival benefit compared to remaining on the waitlist to potentially receive an ABOc KT and DDKT
  • ~35% reduction in mortality over the long term compared with waiting for ABOc LDKT or DDKT

Image is for representation purpose only.


ABOc: ABO compatible; ABOi: ABO incompatible; DDKT: Deceased donor kidney transplant; KPD: Kidney paired donation; KT: Kidney transplant; LDKT: Living donor kidney transplant.


  1. Massie AB, Orandi BJ, Waldram MM, Luo X, Nguyen AQ, Montgomery RA, et al. Impact of ABO-Incompatible Living Donor Kidney Transplantation on Patient Survival. Am J Kidney Dis. 2020 Nov;76(5):616-623.