A Safe Anti-A2 Titer for a Successful A2 Incompatible Kidney Transplantation: A Single-center Experience and Review of the Literature

Autor: Yorg Azzi, MD, Gayatri Nair, MD, Pablo Loarte-Campos, MD, Maria Ajaimy, MD, Jay Graham, MD, Luz Liriano-Ward, MD, Cindy Pynadath, MD, Joan Uehlinger, MD, Michael Parides, PhD, Alesa Campbell, PharmD, Adriana Colovai, PhD, Omar Alani, MD, Marie Le, MD, Stuart Greenstein, MD, Milan Kinkhabwala, MD, Juan Rocca, MD, Enver Akalin, MD
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Transplantation Direct, Vol 7, Iss 2, p e662 (2021)
Druh dokumentu: article
ISSN: 2373-8731
00000000
DOI: 10.1097/TXD.0000000000001099
Popis: 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.
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