PURPOSE: The role of postoperative anti-ABO titers in acute rejection under our current immunosuppressive regimen remains unclear. Some institutions recommend postoperative therapeutic plasma exchange to prevent antibody-mediated rejection (AMR). We investigated the relevance of the postoperative anti-ABO titer rebound and acute rejection in ABO-I KTx to conclude the necessity of B cell targeting therapies for the rebounded anti-ABO antibodies.The purpose of this study is to examine whether postoperative anti-blood type antibody rebound is attributed to kidney allograft rejection in ABO blood type-incompatible (ABO-I) living related kidney transplantation (KTx).

PATIENTS: A total of 191 ABO-I recipients who received ABO-I living related KTx between 2001 and 2013 were divided into two groups: Group 1 consisted of low rebound (≤1:32), N=170, and Group 2 of high rebound (≥1:64), N=21, according to the levels of the rebounded anti-blood type antibodies within one year after transplantation. No prophylactic treatment for rejection was administered for elevated anti-blood type antibodies, regardless of the levels of the rebounded antibodies.

RESULTS: Within one year after transplantation, T cell-mediated rejection was observed in 13 of 170 recipients (13/170, 8 %) in Group 1, and in 2 of 21 recipients (2/21, 10 %) in Group 2 (Groups 1 vs. 2, P=0.432). Antibody-mediated rejection was observed in 15 of 170 recipients (15/170, 9 %) and 2 of 21 recipients (2/21, 10 %) in Groups 1 and 2, respectively (P=0.898). In this study, we found no correlation between the postoperative anti-blood type antibody rebound and the incidence of acute rejection. Serum creatinine levels (sCr) were significantly higher in Group 2 than in Group 1 at two weeks and one month after transplantation (1.48±0.71 and 1.51±0.72 mg/dL in Group 1 vs. 1.72±1.03 and 1.76±1.43 mg/dL in Group 2, respectively) (P=0.012 at 2 weeks, P=0.02 at 1 month). No significant differences in graft function were observed at 3 months, 6 months, 1 year, 3 years, 5 years, or 10 years between the two groups.

CONCLUSIONS: Although the decision of treatment should be made on a case by case basis, we conclude that B cell targeting treatment for postoperatively rebounded anti-ABO antibodies is not necessary in the majority of cases.

CITATION INFORMATION: Ishida H, Kondo T, Shimizu T, Nozaki T, Tanabe K. Postoperative Rebound of Anti-Blood Type Antibodies and Antibody-Mediated Rejection After ABO-Incompatible Living Related Kidney Transplantation – Is Prophylactic Treatment Necessary? Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress