Lack of Correlation between Results of ABO-Incompatible Living Kidney Transplantation and Anti-ABO Blood Type Antibody Titers under Our Current Immunosuppression

Abstract

In this study, we examined the impact of preoperative anti-A/B antibody titers on the results of ABO-incompatible living kidney transplantation (LKT). In all, 167 recipients underwent ABO-incompatible LKT at our institution between 1989 and 2002. These patients were subdivided into those transplanted under cyclosporine with azathioprine or mizoribine (Group 1, n=78) and those transplanted under tacrolimus or mycophenolate mofetil (Group 2, n=89). Overall patient survival at 5 and 10 years was 93.8% and 88.0%, respectively. Overall graft survival at 5 and 10 years was 76.9% and 55.9%, respectively. Graft survival in the patients with anti-A/B IgG titers over 1:128 was significantly lower in group 1, whereas no significant correlation between the anti-A/B IgG titers and graft survival was found in group 2. In conclusion, no correlation between anti-A/B antibody titers and the results of ABO-incompatible LKT was seen after tacrolimus or mycophenolate mofetil application.

ABO Antibody Titer and Risk of Antibody‐Mediated Rejection in ABO‐Incompatible Renal Transplantation

“…After the Japanese group changed from their original quintuple immunosuppressive therapy to tacrolimus, MMF and steroids, however, they did not find a correlation between preoperative ABO antibody titer and graft survival (28). In this study, there was no significant difference in baseline ABO antibody titers between those with and without AMR.…”

Transplanting Against Histocompatibility Barriers

“…However, recent data does not indicate that titers are predictive of early acute rejection and/or poor allograft outcomes. In a study by Shimmura et al pretransplant anti-A/anti-B titers were not found to correlate with graft survival in the patients with anti A/B IgG titers [29]. However, the presence of donor specific anti-HLA antibodies did appear to have a more significant association with poor allograft outcomes than antiblood group antibodies [28].…”

“…However, the positive predictive value of a high anti-A/B titers for AMR was poor (33.3%) [30]. Other studies have found that the absence of mycophenolate mofetil in the conditioning regimens was also associated with an increased risk of rejection [2, [28][29][30].…”

Antibody Mediated Rejection

“…Although this survival was not higher overall than with a group of 78 patients who were treated with cyclosporine and azathioprine, patients with high titers survived at high rates with MMF. It was suggested that MMF prevented formation of antibodies (37).…”