Mechanism of acute antibody-mediated rejection in ABO-incompatible kidney transplantation: which anti-A/anti-B antibodies are responsible, natural or de novo?

摘要

ABO-incompatible living kidney transplantation (ABO-I KTx) has played a role in alleviating the shortage of donor kidneys in countries such as Japan (I). The advent of new immunosuppressive agents and advances in immunosuppressive therapy based on delineation of the mechanism of acute antibody-mediated rejection (AMR) have markedly improved outcomes after ABO-I KTx (2-6). However, acute AMR remains a challenging problem in ABO-I KTx (3,4,6). We examined the time course of the complement 4d (C4d) deposition status in peritu-bular capillaries (PTCs) before and after ABO-I KTx to determine (1) when serum anti-A, anti-B antibodies react with ABO histo-blood group antigens on endothelial cells in PTCs; and (2) which anti-A/anti-B antibodies are responsible, natural or de novo.