Does Immunosuppressive Pharmacotherapy Affect Isoagglutinin
J.-P. Chuang, C.-J. Hung, S.-S. Chang, T.-C. Chou, and P.-C. Lee
Objective. Preoperative reduction of isoagglutinins leads to successful ABO-incompatible
(ABOi) renal transplantation. The strategy includes pretransplantation plasmapheresis,
more potent immunosuppressive drugs, splenectomy, and anti-CD20 antibody. It has been
reported that low isoagglutinin antibody titers posttransplant were observed among ABOi
renal transplants with favorable outcome. The isoagglutinin titers may increase slightly
when plasmapheresis is discontinued; however, it never returns to the pretreatment level
under immunosuppressive therapy. This raises the question of what occurs to the
isoagglutinin titer in ABO-compatible renal transplants under maintenance immunosup-
Methods. We analyzed 10 renal transplant recipients, including seven living and three
cadaveric donors. Patients were treated with basiliximab (20 mg) intravenously on day 0
and day 4. Maintenance immunosuppressive therapy involved a calcineurin inhibitor,
mycophenolate mofetil, and steroid. Anti-human globulin isoagglutinin titers were rou-
tinely examined 1 day before and day 0 and 1, 2, 3, 4, 8, 12, and 24 weeks posttransplant.
No ALG or intravenous immunoglobulin or plasmapheresis treatment was provided in the
Results. Our preliminary data showed nearly no influence on isoagglutinin titer levels in
6-month follow-up under maintenance immunosuppressive therapy. In addition, no
significant difference in isoagglutinin titer was observed between tacrolimus and cyclo-
Conclusion. Maintenance immunosuppressive pharmacotherapy did not affect isoagglu-
tinin titer levels in ABO-compatible kidney transplants. Further study is needed to
investigate the mechanisms of persistent low-level isoagglutinin titers among successful
ABOi renal transplantation patients.
These antigens are expressed not only on the surface of red
blood cells, but also in various organs including the kidneys.
Immunofluorescence studies with monoclonal antibodies
have shown that ABO antigens are located on vascular
endothelium, as well as in the convoluted distal and collect-
ing tubules of the kidney.1 In addition, humans have
antibodies against ABO antigens absent in the individual’s
own tissues according to the law formulated by Land-
steiner.2 Therefore, ABO blood type incompatibility be-
tween a donor and recipient is generally considered to be a
contraindication to kidney transplantation, because of the
risk of preformed antibody-mediated, hyperacute rejection.
HE ABO BLOOD GROUP SYSTEM is the most
important antigen in solid organ transplantation.
The current shortage of cadaveric allografts available for
transplantation is a global problem. In 1987, Alexandre and
colleagues published a historic series of 23 recipients of
ABO-incompatible renal transplants from living donors:
From the Department of Surgery (J.-P.C.), Tainan Hospital,
Taiwan, and Division of Organ Transplantation (C.-J.H., S.-S.C.,
T.-C.C., P.-C.L.), Departments of Surgery, National Cheng Kung
University Hospital, College of Medicine, National Cheng Kung
University, Tainan, Taiwan.
Address reprint requests to Dr Po-Chang Lee, Department of
Surgery, National Cheng Kung University Hospital, College of
Medicine, National Cheng Kung University, 138, Sheng Li Road,
Tainan 70428, Taiwan. E-mail: email@example.com
© 2008 Published by Elsevier Inc.
360 Park Avenue South, New York, NY 10010-1710
0041-1345/08/$–see front matter
Transplantation Proceedings, 40, 2685–2687 (2008)2685