Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Nephron Clin Pract. 2013;124(1-2):79-88. doi: 10.1159/000355855. Epub 2013 Oct 18.
BACKGROUND/AIMS: We investigated the impact of the baseline anti-A/B antibody titer on the clinical outcome in ABO-incompatible kidney transplantation (IKT).
We included 183 patients who had undergone KT (40 ABO IKT and 143 ABO-compatible KT). Eight patients with a baseline titer of ≥1:512 were assigned to the high-titer group and 32 patients with a baseline titer of ≤1:256 were assigned to the low-titer group. Patients who underwent ABO-compatible KT were used as the control group. We compared the clinical outcomes of the three groups.
Before transplantation, the high-titer group displayed more frequent antibody rebound, as shown in a lower titer reduction rate, and more difficulty reaching the target titer (1:16) than the low-titer group. During the postoperative period and out-clinic follow-up, antibody rebound was more frequent, and the rate of acute rejection and infection were significantly higher and allograft function was lower in the high-titer group than in the low-titer and control groups. Multivariate analysis showed that high baseline antibody titer was an independent risk factor for acute rejection.
ABO IKT in the high-titer group (baseline titer ≥1:512) required greater caution compared to the low-titer group because of the higher tendency of antibody rebound and the risk for acute rejection.
背景/目的：我们研究了基线抗 A/B 抗体效价对 ABO 不相容肾移植（IKT）临床结局的影响。
我们纳入了 183 名接受 KT 的患者（40 名 ABO IKT 和 143 名 ABO 相容 KT）。8 名基线效价≥1:512 的患者被分配到高滴度组，32 名基线效价≤1:256 的患者被分配到低滴度组。将接受 ABO 相容 KT 的患者作为对照组。我们比较了三组的临床结局。
移植前，高滴度组抗体反弹更为频繁，表现为滴度降低率较低，且更难达到目标滴度（1:16）。在术后和门诊随访期间，抗体反弹更为频繁，高滴度组的急性排斥反应和感染发生率明显高于低滴度组和对照组，同种异体移植物功能也较低。多变量分析显示，高基线抗体效价是急性排斥反应的独立危险因素。
与低滴度组相比，高滴度组（基线效价≥1:512）的 ABO IKT 需要更加谨慎，因为抗体反弹的趋势更高，发生急性排斥反应的风险更大。
