ABO incompatible LRD kidney transplantation should be offered to children: results from a 33-year comparative OPTN study.

ABOi transplantation is a growing practice with excellent clinical outcomes. Some paediatric transplant programmes are reluctant to offer ABOi transplantation and list children on a DD waiting list. However, there are no studies directly comparing the outcomes between pediatric ABOi LD kidney transplants (LDKTx) and ABOc DD transplants (DDKTx). Data were retrieved on all pediatric kidney transplants from 1987-2020, from the United Network for Organ Sharing. Propensity score matching was used to select a control group of ABOc transplant recipients. Long term outcomes were compared between ABOi and ABOc kidney transplants and between ABOi LDKTx and ABOc DDKTx. Data were compared using chi-square test, t-test and Kaplan-Meier survival analysis. Overall, there were 70 pediatric ABOi kidney transplants meeting the study criteria. There was no significant difference in allograft (p = 0.42) and patient survival (p = 0.58) between ABOi and ABOc transplants. ABOi LDKTx had significantly lower incidence of delayed allograft function and better long-term allograft survival than ABOc DDKTx (p < 0.01, p = 0.01). ABOi transplantation has excellent long-term outcomes. ABOi LDKTx lead to better long-term outcomes than ABOc DDKTx. We recommend that ABOi transplantation from a LD should be considered prior to listing children for transplantation from a DD.