Clinical significance of isoagglutinin titre with the current desensitization protocol in ABO‐incompatible kidney transplantation. Issue 6 (15th April 2019)

• Record Type: Journal Article
• Authors: Baek, Chung Hee; Kim, Hyosang; Yang, Won Seok; Han, Duck Jong; Park, Su‐Kil
• Is Part Of: Nephrology. Volume 24:Issue 6(2019)
• Page Start: 654
• Page End: 660
• Publication Date: 2019-04-15
• Subjects: ABO blood group -- desensitization -- isoagglutinin titre -- kidney transplantation; Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.13412
• Languages: English
• ISSNs: 1320-5358

Abstract

ABSTRACT: Aim: ABO‐incompatible (ABOi) kidney transplantation (KT) has become a routine procedure with graft survival rates comparable to those of ABO‐compatible KT. However, the clinical significance of the isoagglutinin titre in ABOi KT remains uncertain. Therefore, in this study, we analysed the clinical outcomes of ABOi KT according to the baseline and post‐operative isoagglutinin titre. Methods: All patients who received ABOi KT between 2009 and 2013 were reviewed and followed up until December 2016. The patients were classified according to baseline (<1:128 or ≥1:128) and post‐operative rebound isoagglutinin titre (<1:16 or ≥1:16), and the clinical outcomes of KT were compared. Results: Patients with a high baseline isoagglutinin titre showed a poor titre reduction rate (1.48 ± 0.41 vs 1.32 ± 0.34, P = 0.008), and more patients experienced titre rebound ≥1:16 after KT (15.0% vs 35.8%, P = 0.002). The occurrence of both T‐cell‐mediated rejection and antibody‐mediated rejection did not show a significant difference ( P = 0.805 and 0.714, respectively). The rate of rejection‐free survival was not different among groups ( P = 0.680, log–rank test). Furthermore, the rate of death‐censored graft survival was not different among groups ( P = 0.701, log–rank test). Urinary tract infection was the most frequently reported infectious complication overall. The incidence of urinary tract infection, pneumonia and viral infections (BK virus and cytomegalovirus) was not different among groups. Conclusion: In conclusion, high baseline isoagglutinin titre was associated with a high rebound isoagglutinin titre, low titre reduction rates and more sessions of plasmapheresis. However, the isoagglutinin titre may not be as important as it was in the past in ABOi KT if appropriate desensitization is performed. Summary at a Glance: This is a single centre cohort study of 180 patients who have received an ABO‐incompatible kidney transplant between 2009 and 2013. Even though patients with high initial isoagglutinin titre required a greater number of plasmapheresis sessions pre‐transplant and were more likely to experience titre rebound to 1:16, there was no significant difference in acute rejection or allograft survival compared to those with lower initial isoagglutinin titres.