Korean J Transplant.  2021 Oct;35(Supple 1):S81. 10.4285/ATW2021.OP-1066.

ABO-incompatibility and donor-specific antibodies existence effect on antibody-mediated rejection in kidney transplantation

• Choi KW
• Min S
• Jo EA
• Han A
• Ahn S
• Min SK
• Ha J

• KMID: 2521395
• DOI: http://doi.org/10.4285/ATW2021.OP-1066

Abstract

Background
The aim of this study was to identify the incidence of antibody-mediated rejection (ABMR), which was confirmed in postoperative 10-day biopsy depending on the presence or absence of donor-specific antibody (DSA) prior to surgery, in the case of ABO incompatible recipient in kidney transplantation.
Methods
From January 2010 to November 2019, a retrospective study was conducted on patients with ABO incompatible and/or DSA positive among patients who received kidney transplantation at Seoul National University Hospital.
Results
Of the 175 patients identified as ABOi, 17 were DSA(+) patients and 158 were DSA(–) patients. The age of recipient and donor was not much different, and the proportion of women in recipient was higher than that of ABOi DSA(–) in the ABOi DSA(+) group. (76.5% vs 35.4%, P=0.001) Also the proportion of women in the donor was higher than that of ABOi DSA(+) in the ABOi DSA(–) group. (60.8% vs 23.5%, P=0.003) Definitely, the preoperative PRA-1 and PRA-2 positive rates were higher than ABOi DSA(–) in the ABOi DSA(+) group (PRA-1: 58.8% vs. 15.8%, P=0.000 and PRA-2: 76.5% vs. 17.1%, P=0.000). And preoperative PRAMFI max values were high in the ABOi DSA(+) group, with 6,407±1,377, 1,306±277 and P=0.002, respectively. On the 10th day after surgery, the biopsy results showed that ABMR or ABMR+TCMR were 29.4% in ABOi DSA(+) group and 13.3% in ABOi DSA(–) group. The graft survival of these two groups showed no statistically significant results, and the graft survival of the preoperative antibody titer showed no difference between the two groups.
Conclusions
Our data show that ABOi DSA(+) patients and ABOi DSA(–) donors had a large number of women, and the higher the PRA max. value, the higher the positive PRA-1,2, the higher the incidence of ABMR in postoperative biopsies, while there was no significant difference in the preoperative antibody titer.