Long-term isoagglutinin monitoring after ABO-incompatible kidney transplantation

Han Joo Kim; Yousun Chung; Hyungsuk Kim; Youngmin Ko; Young Hoon Kim; Sang-Hyun Hwang; Heung-Bum Oh; Dae-Hyun Ko

doi:10.1093/ajcp/aqae122

Long-term isoagglutinin monitoring after ABO-incompatible kidney transplantation

Am J Clin Pathol. 2024 Sep 10:aqae122. doi: 10.1093/ajcp/aqae122. Online ahead of print.

Authors

Han Joo Kim¹, Yousun Chung², Hyungsuk Kim³, Youngmin Ko⁴, Young Hoon Kim⁴, Sang-Hyun Hwang¹, Heung-Bum Oh¹, Dae-Hyun Ko¹

Affiliations

¹ Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
² Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Seoul, South Korea.
³ Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea.
⁴ Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

PMID: 39255263
DOI: 10.1093/ajcp/aqae122

Abstract

Objectives: This study aimed to evaluate whether a 2-week period of daily isoagglutinin titer testing after ABO-incompatible kidney transplantation (ABOi-KT) is sufficient to ensure successful engraftment and to advocate for an extension of the monitoring duration in specific situations.

Methods: We reviewed patients from January 2022 to December 2023 at Asan Medical Center who underwent therapeutic plasma exchange (TPE) due to elevated ABO antibody titers and suspected acute antibody-mediated rejection (AMR) after ABOi-KT. Data collected included pre- and posttransplantation laboratory results, clinical and procedural information, imaging studies, and needle biopsy results of the renal graft.

Results: We encountered 3 cases of acute AMR 2 weeks after transplantation. All cases exhibited simultaneous increases in anti-ABO antibody isoagglutinin titers, creatinine, and C-reactive protein levels. Clinical signs, including fever, suggested possible infection, and renal graft biopsy, confirmed AMR in all cases. Two cases underwent graftectomy, while the third recovered renal function after conservative treatment, including TPE.

Conclusions: Our findings suggest that a 2-week monitoring period for isoagglutinin titers after ABOi-KT may not be sufficient to detect late AMR. Extending the monitoring duration and considering lifelong fresh-frozen plasma transfusion with graft-compatible blood types, along with periodic isoagglutinin titer testing in cases of suspected AMR, may improve long-term graft outcomes.

Keywords: ABOi-KT; antibody-mediated rejection; isoagglutinin; late rejection.

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