ABO‐incompatible kidney transplantation can be successfully conducted by monitoring IgM isoagglutinin titers during desensitization

• DOI: 10.1111/trf.15672
• Publication Date: 2020-01-20T12:14:36Z
• Authors: Hyungsuk Kim; Wonho Choe; Sung Shin; Young Hoon Kim; Duck‐Jong Han; Su‐Kil Park; Seog‐Woon Kwon; Dae‐Hyun Ko
• Keywords: Adult; Immunosuppression Therapy; Adolescent; Middle Aged; Flow Cytometry; Kidney Transplantation; ABO Blood-Group System; 3. Good health; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Immunoglobulin M; Blood Group Incompatibility; Humans; Aged; Retrospective Studies

BACKGROUNDRecent advances in desensitization techniques and immunosuppressive therapy have led to improved outcomes after ABO‐incompatible (ABO‐i) kidney transplantation (KT). However, questions remain unanswered, particularly regarding which type of ABO isoagglutinin—immunoglobulin M (IgM) or immunoglobulin M (IgG)—is significantly involved in antibody‐mediated rejection (AMR).STUDY DESIGN AND METHODSWe retrospectively analyzed data from 120 patients who underwent ABO‐i KT between 2012 and 2014. Preoperative plasma exchange was performed until the IgM isoagglutinin titer was 4 or less, regardless of the IgG titer. Clinical data were compared between patient groups with pre‐KT IgG isoagglutinin titer 16 or greater (high IgG; titer range, 16‐256; n = 39) and 8 or less (low IgG; titer range, −8; n = 81).RESULTSThe median follow‐up periods were 59 (high IgG) and 55 (low IgG) months. Patient survival at 5 years (p = 0.314) was 100% (high IgG) and 97.4% (low IgG). Graft survival at 5 years (p = 0.480) was 100% (high IgG) and 98.7% (low IgG). AMR by anti‐ABO antibody occurred in only one patient in the low‐IgG group.CONCLUSIONPatients with high pre‐KT IgG isoagglutinin titers had equally successful outcomes as those with low IgG titers. ABO‐i KT can be successfully performed by reducing the pre‐KT IgM isoagglutinin titer to 4 or less, as determined by the immediate spin tube method.