Long-term renal function and complication profiles after ABO-incompatible vs compatible living-donor kidney transplantation: A single-center experience

doi:10.5500/wjt.v16.i2.115329

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Transplant. Jun 18, 2026; 16(2): 115329
Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.115329

Table 1 General population characteristics and comparison between ABO-incompatible and ABO-compatible groups, n (%)

	ABOi (n = 22)	ABOc (n = 186)	P value
Age at transplantation, years, mean ± SD (min-max)	45.8 ± 9 (28.7-60.0)	45.3 ± 13.5 (7.8-74.1)	0.088
Recipient BMI, kg/m², median (IQR) [min-max]	23.9 (20.0-24.8) [17.9-30.7]	23.4 (22.4-25.7) [16.3-34.3]	0.96
Time on KRT, months, median (IQR)[min-max]	10.0 (0-28.0) [0-158.2]	6.3 (2.0-34.0) [0-370.5]	0.225
Gender, male	17 (77.3)	118 (63.4)	0.335
DM	1 (4.5)	16 (8.6)	1
Active smoking	6 (27.3)	43 (23.1)	0.664
Hypertension	19 (86.4)	144 (77.4)	0.422
Cardiac disease	2 (9.1)	17 (9.1)	1
Peripheral artery disease	0 (0)	3 (1.6)	1
Cerebrovascular disease	0 (0)	5 (2.7)	1
Previous history of cancer	0 (0)	4 (2.2)	1
Previous type of KRT			0.174
Hemodialysis	10 (45.5)	86 (46.2)
Peritoneal dialysis	8 (36.4)	34 (18.3)
Preemptive	4 (18.2)	61 (32.8)
Transplant	0	1 (0.5)
History of previous kidney transplant	2 (9.1)	23 (12.4)	1
Induction therapy
Basiliximab	22 (100)	171 (91.9)	0.377
Thymoglobulin	0 (0)	15 (8.1)
HCV positive	0 (0)	3 (2.2)	1
Recipient CMV seropositive	18 (85.7)	155 (84.2)	1
Donor CMV seropositive	14 (87.5)	129 (91.5)	0.638
HLA-A mismatches
0	5 (22.7)	48 (25.9)	0.947
1	12 (54.5)	96 (51.9)
2	5 (22.7)	41 (22.2)
HLA-B mismatches
0	3 (13.6)	27 (14.6)	0.625
1	9 (40.9)	93 (50.3)
2	10 (45.5)	65 (35.1)
HLA-DR mismatches
0	3 (13.6)	37 (20.0)	0.774
1	12 (54.5)	94 (50.8)
2	7 (31.8)	54 (29.2)

Percentages are calculated on available data. Missing values were excluded. IQR: Interquartile range; ABOi: ABO-incompatible; ABOc: ABO-compatible; BMI: Body mass index; HLA: Human leukocyte antigen; CMV: Cytomegalovirus; HCV: Hepatitis C virus; DM: Diabetes mellitus; KRT: Kidney replacement therapy.

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Table 2 Outcomes regarding graft and patient death, n (%)

	ABOi (n = 22)	ABOc (n = 186)	P value
Graft death	0 (0)	17 (9.1)¹	0.226
Patient death	0 (0)	6 (3.2)¹	1

¹Percentages are raw counts and not adjusted for follow-up time.

ABOi: ABO-incompatible; ABOc: ABO-compatible.

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Table 3 Infections in the immediate post-transplant period, n (%)

	ABOi (n = 22)	ABOc (n = 188)	P value	OR (95%CI)
CMV infection	3 (13.6)	16 (8.6)	0.432	-
BK infection	1 (4.5)	30 (16.1)	0.211	-
Sepsis	1 (4.5)	4 (2.2)	0.431	-
Pneumonia	0 (0.0)	2 (1.1)	1	-
Urinary tract infection	5 (22.7)	34 (18.3)	0.572	1.3 (0.5-3.8)
Surgical wound infection	0 (0.0)	2 (1.1)	1.000	-

P values were obtained using Fisher’s exact test. OR (95%CI) shown only when calculable. CMV: Cytomegalovirus; BK: BK polyomavirus; ABOi: ABO-incompatible; ABOc: ABO-compatible; OR: Odds ratio; CI: Confidence interval.

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Table 4 Comparison between groups regarding infections 1 year after transplant, n (%)

	ABO incompatible (n = 22)	ABO compatible (n = 186)	P value	OR (95%CI)
Sepsis	1 (4.5)	3 (1.7)	0.375¹	2.8 (0.3-27.9)
Pneumonia	0 (0.0)	2 (1.1)	1.000	-
Urinary tract infection	3 (13.6)	26 (13.8)	0.895¹	0.92 (0.3-3.3)
CMV infection	3 (13.6)	15 (8.1)	0.431¹	1.7 (0.5-6.4)
BK infection	1 (4.5)	30 (16.1)	0.165¹	0.2 (0.0-1.8)

¹P value obtained by univariate binary logistic regression.

P values were obtained using Fisher’s exact test when logistic regression was not possible. CMV: Cytomegalovirus; BK: BK polyomavirus; OR: Odds ratio; CI: Confidence interval.

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Table 5 Comparison between estimated glomerular filtration rate at 1, 3, 6, 12, 24, 36, 48 and 60 months

	ABO incompatible (n = 22)	ABO compatible (n = 186)	P value
eGFR at 1-month, median (IQR)	66.1 (43.0-70.6)	66.3 (53.5-82.4)	0.485
eGFR at 3 months, median (IQR)	60.9 (37.7-75.7)	58.6 (46.4-76.8)	0.838
eGFR at 6 months, median (IQR)	52.6 (39.6-79.8)	62.0 (45.8-80.3)	0.926
eGFR at 12 months, median (IQR)	54.8 (47.6-66.5)	58.2 (47.0-77.1)	0.086
eGFR at 24 months, median (IQR)	65.5 (58.2-93.0)	58.5 (42.7-75.1)	0.188
eGFR at 36 months, median (IQR)	80.7 (44.1-94.5)	60.4 (49.2-81.3)	0.825
eGFR at 48 months, median (IQR)	63.1 (42.0-87.9)	66.7 (42.0-87.9)	0.675
eGFR at 60 months, median (IQR)	62.2 (43.2-94.2)	62.5 (45.3-78.4)	0.734

eGFR: Estimated glomerular filtration rate; IQR: Interquartile range.

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Table 6 Comparison between proteinuria at 1, 3, 6, 12, 24, 36, 48 and 60 months

	ABO incompatible (n = 22)	ABO compatible (n = 186)	P value
Proteinuria (g/L) at 1 month, median (IQR)	0.4 (0.1-0.7)	0.2 (0.1-0.3)	0.535
Proteinuria (g/L) at 3 months, median (IQR)	0.1 (0.1-0.8)	0.1 (0.1-0.2)	0.111
Proteinuria (g/L) at 6 months, median (IQR)	0.1 (0.1-0.5)	0.1 (0.1-0.2)	0.985
Proteinuria (g/L) at 12 months, median (IQR)	0.1 (0.1-0.3)	0.1 (0.1-0.1)	0.475
Proteinuria (g/L) at 24 months, median (IQR)	0.1 (0.0-0.3)	0.1 (0.1-0.2)	0.432
Proteinuria (g/L) at 36 months, median (IQR)	0.1 (0.1-0.8)	0.1 (0.1-0.2)	0.326
Proteinuria (g/L) at 48 months median (IQR)	0.1 (0.1-0.5)	0.1 (0.1-0.1)	0.482
Proteinuria (g/L) at 60 months, median (IQR)	0.1 (0.1-0.4)	0.1 (0.1-0.1)	0.518

IQR: Interquartile range.

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Citation: Braga BG, Cunha A, Almeida M, Sousa S, Trigo AF, Inácio A, Dias B, Silvano J, Ribeiro C, Pedroso S, Sampaio M, Bini-Antunes M, Martins LS. Long-term renal function and complication profiles after ABO-incompatible vs compatible living-donor kidney transplantation: A single-center experience. World J Transplant 2026; 16(2): 115329
URL: https://www.wjgnet.com/2220-3230/full/v16/i2/115329.htm
DOI: https://dx.doi.org/10.5500/wjt.v16.i2.115329

Braga BG, Cunha A, Almeida M, Sousa S, Trigo AF, Inácio A, Dias B, Silvano J, Ribeiro C, Pedroso S, Sampaio M, Bini-Antunes M, Martins LS. Long-term renal function and complication profiles after ABO-incompatible vs compatible living-donor kidney transplantation: A single-center experience. World J Transplant 2026; 16(2): 115329 [DOI: 10.5500/wjt.v16.i2.115329]

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