Ann Lab Med.  2017 May;37(3):254-260. 10.3343/alm.2017.37.3.254.

Effects of Neutralization by Soluble ABH Antigens Produced by Transplanted Kidneys From ABO-Incompatible Secretor Donors

• Kim J
• Kim S
• Hwang IS
• Choi JR
• Lee JG
• Kim YS
• Kim MS
• Kim HO

• KMID: 2369751
• DOI: http://doi.org/10.3343/alm.2017.37.3.254

Abstract

BACKGROUND
Grafts survive despite blood group antigens on the transplant being continuously exposed to antibodies in the blood of recipients in ABO-incompatible kidney transplantation (ABOi KT), owing to the mechanism of accommodation. We analyzed the immunodynamics of soluble ABH antigens in allografts from secretor donors and the influence of such immunodynamics on accommodation and subsequent graft survival in ABOi KT.
METHODS
The genotype of a known human β-galactoside α-1,2-fucosyltransferase gene (FUT2), which determines soluble ABH antigen secretor status, was established in 32 donors for ABOi KT at the Severance Hospital, from June 2010 to July 2015. Clinical outcomes of recipients, such as anti-A/B antibody titer change, renal function, and graft survival, were evaluated.
RESULTS
Twenty-five donors were secretors (78.1%), and seven were nonsecretors (21.9%). The frequency of anti-A/B IgG or IgM antibody titer elevation or reduction post-transplantation was not significantly related to donor secretor status. However, IgM titer was rapidly reduced in recipients transplanted from nonsecretor donors (P=0.01), which could be explained by the lack of absorption effect of soluble antigens, enhancing the binding of antibodies to antigens in the allografts. Interestingly, soluble ABH antigens did not affect rejection-free graft survival, which may be due to the nature of β-galactoside α-1,2-fucosyltransferase.
CONCLUSIONS
Soluble ABH antigens produced by transplanted kidneys from secretor donors played a role in inducing accommodation within three months of KT through neutralization; however, major graft outcomes were not affected.

Keyword

Blood group incompatibility; Kidney transplantation; Blood group antigens; β-galactoside α-1,2-fucosyltransferase; Graft survival

MeSH Terms

Absorption
Allografts
Antibodies
Blood Group Antigens
Blood Group Incompatibility
Genotype
Graft Survival
Humans
Immunoglobulin G
Immunoglobulin M
Kidney Transplantation
Kidney*
Tissue Donors*
Transplants
Antibodies
Blood Group Antigens
Immunoglobulin G
Immunoglobulin M

Figure

• 

  Fig. 1 The time (days) required for onefold elevation of IgG and IgM and reduction of IgG after transplant according to recipient groups. The box plot shows the median (bold line), the first quartile (lower border of the box) and the third quartile (upper border of the box).

• 

  Fig. 2 Rejection-free graft survival within one month post-transplantation (A) and within one year post-transplantation between groups (B). The differences in survival rates were not significant at both time points (95% confidence interval, 27.8–31.6, P=0.960 for one month; 286.4–359.8, P=0.943 for one year).

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