A retrospective cohort study of infective complications and graft outcomes over 5 years in ABO-incompatible kidney transplant recipients: experience from a tertiary care centre in Saudi Arabia.

BACKGROUND

ABO-incompatible (ABOi) kidney transplantation is increasingly utilized to address donor shortages in end-stage kidney disease (ESKD) patients. However, the impact of immunosuppressive regimens on infection risks remains a concern. This study examines the spectrum of infections, associated risk factors, and their influence on graft outcomes over a 5-year period.

METHODS

A retrospective cohort study of 24 adult ABOi kidney transplant recipients (2015-2019) was conducted, with follow-up until December 2024. Desensitization included rituximab, plasma exchange (PLEX), and IV immunoglobulin (IVIG). Infections were classified as bacterial, viral, and fungal infections; and the studied outcomes included incidence of infection and their associations with age, gender, comorbidities, graft survival, and graft rejection.

RESULTS

A total of 49 infectious episodes were recorded in 19 patients (79.2%); 5 patients had infection free follow-up of plus 5 years. Urinary tract infections (UTIs) were most common (23/49), followed by COVID-19 (11/49) and Influenza A (7/49). No episode of fungal infection was observed. Infection incidence was highest in females (52.6%), diabetics (47.4%), and patients with prior rejection episodes (10.5%). Kaplan-Meier analysis showed significantly lower infection-free survival in patients with graft rejection (P = 0.0086). Despite frequent infections, overall graft survival remained high (91.7%), with no direct statistical association between infections and rejection.

CONCLUSION

Infections are prevalent in ABOi kidney transplant recipients, particularly in high-risk subgroups, including females, patients with diabetes and prior graft rejection. However, long-term graft survival remains favorable with no association between infections and graft rejection. Optimized immunosuppression and infection surveillance are crucial for improving patient outcomes. Larger multicenter studies are warranted to validate these findings.