Korean J Transplant.  2022 Nov;36(Supple 1):S315. 10.4285/ATW2022.F-4539.

Long-term clinical outcomes of ABO incompatible kidney transplantation in patients with high baseline anti-A/B antibody titer

  • 1Department of Nephrology, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea
  • 2Department of Nephrology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea


ABO incompatible (ABOi) kidney transplantation (KT) has been considered to overcome donor shortage. We investigated the long-term clinical outcomes in ABOi KT in patients with high baseline anti-A/B antibody titer.
We retrospectively included 271 patients who had undergone ABOi KT from May, 2009 to February, 2021. One hundred and ninety-one patients with a baseline immunoglobulin G (IgG) titer of higher than 1:128 were assigned to the high-titer group and 80 patients with a baseline titer of lower than 1:64 were assigned to the low-titer group. We used a protocol com-posed of rituximab, plasmapheresis, and intravenous immunoglobulin (RTX/PP/IVIG). We compared the clinical outcomes of the two groups.
The median follow-up periods were 59.12 months (high-titer group) and 41.53 months (low-titer group) (P=0.003). The high-titer group required more sessions of PP/IVIG than the low titer group (7.50±2.47 vs. 3.39±1.30; P<0.001, respectively). Patient survival rate at 5 years was 93.80% in high-titer and 96.30% in low-titer group. Graft survival rate at 5 years was 90.00% in high-titer and 92.60% in low-titer group. During the follow-up period, serum creatinine and urine protein-to-creatinine ratio showed no difference between two groups up to nine years (P for interaction=0.171). No significant differences were detected in the graft survival rate, patient survival rate and rejection-free survival rate between two groups. However, the infection-free survival rate was significantly lower in the high-titer group (P=0.049). The incidence of bacterial infection was higher in high-ti-ter group (45.00% vs. 28.27%, P=0.008).
Patients with high baseline anti-A/B IgG isoagglutinin titers had equally successful long-term outcomes as those with low titers. However, the high baseline antibody titer may require greater caution because of the higher tendency of infection.

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