A Safe Anti-A2 Titer for a Successful A2 Incompatible Kidney Transplantation : A Single-center Experience and Review of the Literature
Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc..
BACKGROUND: Kidney allocation system allows blood type B candidates accept kidneys from A2/A2B donors. There is no mandate by UNOS on which the anti-A2 level is acceptable. We aimed to investigate the safety of kidney transplant in blood group B patients with anti-A2 titers ≤16.
METHODS: We performed 41 A2-incompatible kidney transplants in blood group B recipients between May 2015 and September 2019. Clinical outcomes were compared with a control group of 75 blood group B recipients who received blood group compatible kidney transplantation at the same period.
RESULTS: Of the 41 recipients, 85% were male, 48% African American, with a median age of 53 (20-73) y. Thirty-eight (93%) were deceased-donor and 3 (7%) were living-donor kidney transplant recipients. Pretransplant anti-A2 IgG titers were 2 in 16, 4 in 9, 8 in 6, and 16 in 5 and too weak to titer in 5 recipients. Eight patients had pretransplant donor-specific antibodies. During a median follow-up of 32.6 mo (6-57.3) patient and graft survival were 100% and 92% in the A2-incompatible kidney transplant group, and 91% and 92% in the blood group compatible group, respectively. Twelve A2-incompatible recipients underwent a 21 clinically indicated kidney biopsies at a median 28 d (6-390) after transplantation. None of the patients developed acute antibody-mediated rejection and 2 patients (5%) had acute T-cell-mediated rejection. Interestingly, peritubular capillary C4d positivity was seen in 7 biopsies which did not have any findings of acute rejection or microvascular inflammation but not in any of the rejection-free biopsies in the control group. C4d positivity was persistent in 5 of those patients who had follow-up biopsies.
CONCLUSIONS: A2-incompatible transplantation is safe in patients with anti-A2 titers ≤16 with excellent short-term kidney allograft outcomes. C4d positivity is frequent in allograft biopsies without acute rejection.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:7 |
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| Enthalten in: |
Transplantation direct - 7(2021), 2 vom: 15. Feb., Seite e662 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Azzi, Yorg [VerfasserIn] |
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| Anmerkungen: |
Date Revised 20.04.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1097/TXD.0000000000001099 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM320824500 |
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| 100 | 1 | |a Azzi, Yorg |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A Safe Anti-A2 Titer for a Successful A2 Incompatible Kidney Transplantation |b A Single-center Experience and Review of the Literature |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Revised 20.04.2022 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. | ||
| 520 | |a BACKGROUND: Kidney allocation system allows blood type B candidates accept kidneys from A2/A2B donors. There is no mandate by UNOS on which the anti-A2 level is acceptable. We aimed to investigate the safety of kidney transplant in blood group B patients with anti-A2 titers ≤16 | ||
| 520 | |a METHODS: We performed 41 A2-incompatible kidney transplants in blood group B recipients between May 2015 and September 2019. Clinical outcomes were compared with a control group of 75 blood group B recipients who received blood group compatible kidney transplantation at the same period | ||
| 520 | |a RESULTS: Of the 41 recipients, 85% were male, 48% African American, with a median age of 53 (20-73) y. Thirty-eight (93%) were deceased-donor and 3 (7%) were living-donor kidney transplant recipients. Pretransplant anti-A2 IgG titers were 2 in 16, 4 in 9, 8 in 6, and 16 in 5 and too weak to titer in 5 recipients. Eight patients had pretransplant donor-specific antibodies. During a median follow-up of 32.6 mo (6-57.3) patient and graft survival were 100% and 92% in the A2-incompatible kidney transplant group, and 91% and 92% in the blood group compatible group, respectively. Twelve A2-incompatible recipients underwent a 21 clinically indicated kidney biopsies at a median 28 d (6-390) after transplantation. None of the patients developed acute antibody-mediated rejection and 2 patients (5%) had acute T-cell-mediated rejection. Interestingly, peritubular capillary C4d positivity was seen in 7 biopsies which did not have any findings of acute rejection or microvascular inflammation but not in any of the rejection-free biopsies in the control group. C4d positivity was persistent in 5 of those patients who had follow-up biopsies | ||
| 520 | |a CONCLUSIONS: A2-incompatible transplantation is safe in patients with anti-A2 titers ≤16 with excellent short-term kidney allograft outcomes. C4d positivity is frequent in allograft biopsies without acute rejection | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Loarte-Campos, Pablo |e verfasserin |4 aut | |
| 700 | 1 | |a Ajaimy, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Graham, Jay |e verfasserin |4 aut | |
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| 700 | 1 | |a Pynadath, Cindy |e verfasserin |4 aut | |
| 700 | 1 | |a Uehlinger, Joan |e verfasserin |4 aut | |
| 700 | 1 | |a Parides, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Campbell, Alesa |e verfasserin |4 aut | |
| 700 | 1 | |a Colovai, Adriana |e verfasserin |4 aut | |
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| 700 | 1 | |a Akalin, Enver |e verfasserin |4 aut | |
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