Ann Lab Med 2017; 37(3): 254-260  https://doi.org/10.3343/alm.2017.37.3.254
Effects of Neutralization by Soluble ABH Antigens Produced by Transplanted Kidneys From ABO-Incompatible Secretor Donors
Jieun Kim, M.D.1, Sinyoung Kim, M.D.1, In Sik Hwang, M.S.2, Jong Rak Choi, M.D.1, Jae Geun Lee, M.D.3,4, Yu Seun Kim, M.D.3,4, Myoung Soo Kim, M.D.3,4, and Hyun Ok Kim, M.D.1
Department of Laboratory Medicine1, Brain Korea 21 PLUS Project for Medical Science2, Department of Surgery3, Research Institute for Transplantation4, Yonsei University College of Medicine, Seoul, Korea
Correspondence to: Hyun Ok Kim
Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Tel: +82-2-2228-2444
Fax: +82-2-313-0956
E-mail: hyunok1019@yuhs.ac
Myoung Soo Kim
Department of Surgery and Research Institute for Transplantation, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Tel: +82-2228-2123
Fax: +82-2-313-8289 E-mail: ysms91@yuhs.ac
Received: June 20, 2016; Revised: August 11, 2016; Accepted: December 21, 2016; Published online: May 1, 2017.
© The Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Grafts survive despite blood group antigens on the transplant being continuously exposed to antibodies in the blood of recipients in ABO-incompatible kidney transplantation (ABOi KT), owing to the mechanism of accommodation. We analyzed the immunodynamics of soluble ABH antigens in allografts from secretor donors and the influence of such immunodynamics on accommodation and subsequent graft survival in ABOi KT.
Methods: The genotype of a known human β-galactoside α-1,2-fucosyltransferase gene (FUT2), which determines soluble ABH antigen secretor status, was established in 32 donors for ABOi KT at the Severance Hospital, from June 2010 to July 2015. Clinical outcomes of recipients, such as anti-A/B antibody titer change, renal function, and graft survival, were evaluated.
Results: Twenty-five donors were secretors (78.1%), and seven were nonsecretors (21.9%). The frequency of anti-A/B IgG or IgM antibody titer elevation or reduction post-transplantation was not significantly related to donor secretor status. However, IgM titer was rapidly reduced in recipients transplanted from nonsecretor donors (P=0.01), which could be explained by the lack of absorption effect of soluble antigens, enhancing the binding of antibodies to antigens in the allografts. Interestingly, soluble ABH antigens did not affect rejection-free graft survival, which may be due to the nature of β-galactoside α-1,2-fucosyltransferase.
Conclusions: Soluble ABH antigens produced by transplanted kidneys from secretor donors played a role in inducing accommodation within three months of KT through neutralization; however, major graft outcomes were not affected.
Keywords: Blood group incompatibility, Kidney transplantation, Blood group antigens, β-galactoside α-1,2-fucosyltransferase, Graft survival


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