ORIGINAL RESEARCH article
Front. Immunol.
Sec. Alloimmunity and Transplantation
This article is part of the Research TopicCommunity Series in Renal Fibrosis and Renal Transplantation: Vol. IIView all 13 articles
The Viability of ABO-Incompatible Kidney Transplants: A Single-Center Cohort in China
Provisionally accepted
Yiding Chen
Jiashan Pan
Dongsheng Li
Kun Wang
Handong Ding
Fei Zhang
Wenbo Wang
Pengfei LiJinbiao Zhong
Guiyi Liao*- Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, China
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Background: ABO-incompatible living donor kidney transplantation (ABOi-LDKT) offers a potential solution to organ shortages, but its safety and economic impact in China remain uncertain. This study evaluated short-to mid-term outcomes of ABOi-LDKT in a Chinese population by integrating evidence from a meta-analysis and a single-center cohort. Methods: We performed a meta-analysis of 18 studies including 15,611 kidney transplant recipients to compare graft and patient survival between ABOi-LDKT and ABO-compatible LDKT (ABOc-LDKT). In parallel, we conducted a retrospective single-center cohort study of 41 ABOi-LDKT and 132 ABOc-LDKT recipients transplanted between 2021 and 2022. Outcomes included patient and graft survival, renal function, postoperative complications, infections, delayed graft function (DGF), acute rejection, and hospitalization costs. Results: The meta-analysis showed lower 1-year graft survival and 3-year patient survival in ABOi-LDKT than in ABOc-LDKT. In contrast, our single-center cohort demonstrated comparable 1-and 3-year patient and graft survival between groups. No significant differences were observed in surgical complications, infections, DGF, or acute rejection. ABOi-LDKT recipients showed better renal function at two weeks post-transplant, with no sustained differences thereafter. Hospitalization costs were higher in the ABOi-LDKT group, reflecting additional desensitization procedures. Conclusion: In this Chinese single-center cohort, ABOi-LDKT achieved short-to mid-term clinical outcomes comparable to ABOc-LDKT despite higher upfront costs. When combined with contemporary desensitization protocols, ABOi-LDKT appears to be a safe and feasible strategy to expand access to living donor kidney transplantation in settings with severe organ shortages.
Keywords: ABO-incompatible living donor kidney transplantation1, Desensitization 2, Graftsurviva3, meta-analysis4, Postoperative outcomes5
Received: 16 Nov 2025; Accepted: 26 Jan 2026.
Copyright: © 2026 Chen, Pan, Li, Wang, Ding, Zhang, Wang, Li, Zhong and Liao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Guiyi Liao
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