Introduction: ABO incompatible kidney transplantation has expanded the living donor pool in India where there is lack of an effective deceased donor programme. Though certain studies have shown comparable short term outcomes of ABOiKT vs. ABOcKT, we have evaluated and compared medium term outcomes of the same.

Methods: 75 ABOiKT recipients (ABOiKTR)(case) and 75 age and sex matched ABOcKTR (control group) who had undergone kidney transplantation from August 2015 to August 2018 were included in this study. ABOiKTR were desensitized according to institutional protocol. They were followed up on OPD basis and on IPD admissions (if any) from September 2019 till August 2021 for 24 months in the form of clinical evaluations and relevant investigations conducted at interval of 4 months. The outcomes of both the groups were compared in terms of patient survival, graft survival, graft function,incidence of rejections and infective complications.

Results: Most of the patients (54.6%) had IgG Ab titre in the range of 1:128 to 1:512.Highest baseline titre transplanted was 4096. Patients with high titre isohaemagglutinins before transplantation had comparable medium term results with low-titre isohaemagglutinin patients. The overall duration (mean ± SD) of follow-up was 57.9 ± 10 months with a median (IQR) of 59.5(50-67) months. The graft function was excellent (S.Cr < 1.5) in 72% ABOc and 73.3% ABOi patients at the end of study period. There was no significant difference in the mean creatinine level at follow up between ABOc and ABOi groups (p>0.05).Patient survival was 93.3% in ABOc and 90.7% in ABOi transplants at the end of the study period (p>0.05). Death censored graft survival was 100% in both the groups. There were 12 biopsy proven rejections (8%) of the graft kidney (5 in ABOc group and 7 in ABOi group) with no significant difference of rejection between two groups. ACR was the most common cause of rejection (4%) followed by ABMR and mixed rejection(2.7% and 1.3% respectively). The highest prevalent serious infection was pneumonia (10.7%) followed by sepsis (7.3%), UTI (6%) and GI infection (5.3%) with no significant association between two groups (p>0.05).No cases of CMV or BKV infection was reported.

Conclusion: The medium term outcome of ABOiKT over 3-6 years was comparable with ABOcKT. Financial cost was also much less in the preconditioning protocol of our institute which included rituximab, plasmapheresis and IVIG. Thus, financially poor patients could afford kidney transplantation from blood group incompatible donors amongst the family members with similar medium term graft outcomes.