ABO血型不相容肾移植后肾移植受者对供者ABO抗原的低反应性

Hyporesponsiveness against donor's ABO antigens of renal grafts after ABO-incompatible kidney transplantation.

作者信息

Tasaki Masayuki, Tateno Hiroaki, Sato Takashi, Narimatsu Hisashi, Saito Kazuhide, Nakagawa Yuki, Aoki Toshinari, Kamimura Masami, Ushiki Takashi, Takahashi Kota, Tomita Yoshihiko

机构信息

Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-dori, Chuo-ku, Niigata, Japan.

Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan.

出版信息

Clin Exp Nephrol. 2023 Jan;27(1):89-95. doi: 10.1007/s10157-022-02280-3. Epub 2022 Oct 8.

DOI:10.1007/s10157-022-02280-3

PMID:36209259

Abstract

BACKGROUND

ABO antigens expressed on the red blood cells (RBCs) are not identical to those expressed on the renal endothelial cells. The isohemagglutinin assay employing the RBCs is the gold standard for evaluating anti-ABO antibody (Ab) levels. However, it remains unclear whether the anti-ABO Abs detected by the isohemagglutinin assay after ABO-incompatible (ABOi) kidney transplantations (KTx) that are not associated with antibody-mediated rejection can bind to renal graft endothelial cells.

METHODS

Ninety plasma samples were collected from patients with stable graft function after ABO-compatible (ABOc) or ABOi KTx. Anti-ABO Ab titers were examined by both the isohemagglutinin assay and the CD31-ABO microarray, which was developed as a mimic of the ABO antigens expressed on the renal endothelial cells.

RESULTS

The antibody titers detected by the isohemagglutinin assay and the CD31-ABO microarray after the ABOc KTx relatively correlated with each other. However, the CD31-ABO microarray results showed low antibody levels against donor blood group antigens after ABOi KTx and did not correlate with the isohemagglutinin assay. In contrast, the antibody levels against non-donor blood group antigens after ABOi KTx were comparable to those after the ABOc KTx. Fourteen patients received graft biopsies, and no antibody-mediated rejection was observed in ABOi KTx recipients, except for two patients who had anti-donor-HLA Abs.

CONCLUSION

The present study suggested that the anti-ABO Abs detected by the isohemagglutinin assay after ABOi KTx with stable graft function were hyporeactive to the ABO antigen of graft renal endothelial cells.

摘要

背景

红细胞（RBC）上表达的ABO抗原与肾内皮细胞上表达的ABO抗原并不相同。采用红细胞的同种血凝素测定法是评估抗ABO抗体（Ab）水平的金标准。然而，在不伴有抗体介导排斥反应的ABO血型不相容（ABOi）肾移植（KTx）后，通过同种血凝素测定法检测到的抗ABO抗体是否能与肾移植内皮细胞结合仍不清楚。

方法

从ABO血型相容（ABOc）或ABOi肾移植术后移植功能稳定的患者中收集90份血浆样本。通过同种血凝素测定法和CD31-ABO微阵列检测抗ABO抗体滴度，CD31-ABO微阵列是作为肾内皮细胞上表达的ABO抗原的模拟物开发的。

结果

ABOc肾移植后通过同种血凝素测定法和CD31-ABO微阵列检测到的抗体滴度相对彼此相关。然而，CD31-ABO微阵列结果显示ABOi肾移植后针对供体血型抗原的抗体水平较低，且与同种血凝素测定法不相关。相比之下，ABOi肾移植后针对非供体血型抗原的抗体水平与ABOc肾移植后的相当。14例患者接受了移植肾活检，除2例有抗供体HLA抗体的患者外，ABOi肾移植受者未观察到抗体介导的排斥反应。