Effect of Donor and Recipient ABH-Secretor Status on ABO-Incompatible Living Donor Kidney Transplantation

Abstract

IntroductionABO blood group antigens within grafts are continuously exposed to anti-A/B antibodies in the serum of recipients after ABO-incompatible (ABOi) kidney transplantation and are instrumental in antibody-mediated rejection. Some individuals secrete soluble blood group antigens into body fluids. In this study, we investigated the effect of donor and recipient secretor status on the outcomes of ABOi kidney transplantation.MethodsData of a total of 32 patients with ABOi living donor kidney transplantation were retrospectively collected between 2014 and 2020 in West China Hospital. The genotype and phenotype of both donors and recipients were examined and evaluated with post-transplantation anti-A/B titer changes, graft function, and rejection.ResultsOf the 32 recipients and 32 donors, 23 (71.9%) recipients and 27 (84.4%) donors had secretor genotypes, whereas 9 (28.1%) recipients and 5 (15.6%) donors did not. Anti-A/B titers after ABOi kidney transplantation were not significantly influenced by the secretor status of either donors or recipients. The post-transplantation serum creatinine (Scr) levels and estimated glomerular filtration rate (eGFR) was better in weak- or non-secretor recipients at day 30 (Scr P = 0.047, eGFR P = 0.008), day 90 (Scr P = 0.010, eGFR P = 0.005), and month 9 (eGFR P = 0.008), and recipients from secretor donors had a lower incidence of graft rejection in the first year after ABOi transplantation (P = 0.004).ConclusionsA weak secretor status phenotype was found in both genotypes, i.e., individuals who secreted soluble antigens as well as those who did not. The recipient ABH-secretor status may have an influence on early posttransplant renal function, and the donor ABH-secretor status might affect the incidence of graft rejection.

Immunoglobulin Class Profiles of ABO Antibodies in Saliva and Serum of Healthy Individuals

“…Performance of flow cytometry was assessed using a high-titer anti-A/anti-B WHO reference reagent (National Institute for Biological Standards and Control, Hertfordshire, England, UK) in a 1-in-2 dilution series (diluted with AB-serum and AB-saliva pools as well as PBS; 5 replicates each). For these experiments, only saliva from non-secretors was employed to ensure the absence of soluble blood group substances; non-secretor status was ascertained using the Wiener agglutination inhibition test [ 13 ]. Precision, dynamic range, and limit of detection were defined as described elsewhere [ 14 , 15 ].…”

“… Parameters were defined according to Armbruster 2008 [ 13 ] and Wood 2013 [ 14 ]. RSD, relative standard deviation; DR, dynamic range (ratio between largest (non-diluted)/smallest (blank) fluorescent signal); LOB, limit of blank (Mean blank + 1.645*SD); LOD, limit of detection (=LOB + 1.645*SD highest dilution).…”

“…Flow cytometric performance assessment determined by dilution of high titer anti-A/anti-B WHO standard with three different diluents in 5 replicates Parameters were defined according to Armbruster 2008[13] and Wood 2013[14]. RSD, relative standard deviation; DR, dynamic range (ratio between largest (non-diluted)/smallest (blank) fluorescent signal); LOB, limit of blank (Mean blank + 1.645*SD); LOD, limit of detection (=LOB + 1.645*SD highest dilution).…”