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Azzi Y, Nair G, Loarte-Campos P, et al. A Safe Anti-A2 Titer for a Successful A2 Incompatible Kidney Transplantation: A Single-center Experience and Review of the Literature. Transplant Direct. 2021;7(2):e662doi: 10.1097/TXD.0000000000001099.
Azzi, Y., Nair, G., Loarte-Campos, P., Ajaimy, M., Graham, J., Liriano-Ward, L., Pynadath, C., Uehlinger, J., Parides, M., Campbell, A., Colovai, A., Alani, O., Le, M., Greenstein, S., Kinkhabwala, M., Rocca, J., & Akalin, E. (2021). A Safe Anti-A2 Titer for a Successful A2 Incompatible Kidney Transplantation: A Single-center Experience and Review of the Literature. Transplantation direct, 7(2), e662. https://doi.org/10.1097/TXD.0000000000001099
Azzi, Yorg, et al. "A Safe Anti-A2 Titer for a Successful A2 Incompatible Kidney Transplantation: A Single-center Experience and Review of the Literature." Transplantation direct vol. 7,2 (2021): e662. doi: https://doi.org/10.1097/TXD.0000000000001099
Azzi Y, Nair G, Loarte-Campos P, Ajaimy M, Graham J, Liriano-Ward L, Pynadath C, Uehlinger J, Parides M, Campbell A, Colovai A, Alani O, Le M, Greenstein S, Kinkhabwala M, Rocca J, Akalin E. A Safe Anti-A2 Titer for a Successful A2 Incompatible Kidney Transplantation: A Single-center Experience and Review of the Literature. Transplant Direct. 2021 Jan 26;7(2):e662. doi: 10.1097/TXD.0000000000001099. eCollection 2021 Feb. PMID: 33521251; PMCID: PMC7837880.
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Transplant Direct. 2021 Jan 26;7(2):e662. doi: 10.1097/TXD.0000000000001099. eCollection 2021 Feb.

A Safe Anti-A2 Titer for a Successful A2 Incompatible Kidney Transplantation: A Single-center Experience and Review of the Literature.

Transplantation direct

Yorg Azzi, Gayatri Nair, Pablo Loarte-Campos, Maria Ajaimy, Jay Graham, Luz Liriano-Ward, Cindy Pynadath, Joan Uehlinger, Michael Parides, Alesa Campbell, Adriana Colovai, Omar Alani, Marie Le, Stuart Greenstein, Milan Kinkhabwala, Juan Rocca, Enver Akalin

Affiliations

  1. Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
  2. North Shore University Hospital/Northwell Health, Transplant Center, Manhasset, NY.
  3. Department of Pathology and Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
  4. Department of Surgery, Montefiore Medical Center Transplant Center, Albert Einstein College of Medicine, Bronx, NY.

PMID: 33521251 PMCID: PMC7837880 DOI: 10.1097/TXD.0000000000001099

Abstract

BACKGROUND: Kidney allocation system allows blood type B candidates accept kidneys from A2/A2B donors. There is no mandate by UNOS on which the anti-A2 level is acceptable. We aimed to investigate the safety of kidney transplant in blood group B patients with anti-A2 titers ≤16.

METHODS: We performed 41 A2-incompatible kidney transplants in blood group B recipients between May 2015 and September 2019. Clinical outcomes were compared with a control group of 75 blood group B recipients who received blood group compatible kidney transplantation at the same period.

RESULTS: Of the 41 recipients, 85% were male, 48% African American, with a median age of 53 (20-73) y. Thirty-eight (93%) were deceased-donor and 3 (7%) were living-donor kidney transplant recipients. Pretransplant anti-A2 IgG titers were 2 in 16, 4 in 9, 8 in 6, and 16 in 5 and too weak to titer in 5 recipients. Eight patients had pretransplant donor-specific antibodies. During a median follow-up of 32.6 mo (6-57.3) patient and graft survival were 100% and 92% in the A2-incompatible kidney transplant group, and 91% and 92% in the blood group compatible group, respectively. Twelve A2-incompatible recipients underwent a 21 clinically indicated kidney biopsies at a median 28 d (6-390) after transplantation. None of the patients developed acute antibody-mediated rejection and 2 patients (5%) had acute T-cell-mediated rejection. Interestingly, peritubular capillary C4d positivity was seen in 7 biopsies which did not have any findings of acute rejection or microvascular inflammation but not in any of the rejection-free biopsies in the control group. C4d positivity was persistent in 5 of those patients who had follow-up biopsies.

CONCLUSIONS: A2-incompatible transplantation is safe in patients with anti-A2 titers ≤16 with excellent short-term kidney allograft outcomes. C4d positivity is frequent in allograft biopsies without acute rejection.

Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.

Conflict of interest statement

The authors declare no funding or conflicts of interest.

References

  1. J Am Coll Surg. 2019 Apr;228(4):635-641 - PubMed
  2. Kidney Int. 2019 Jan;95(1):199-209 - PubMed
  3. J Am Soc Nephrol. 2009 Jan;20(1):197-204 - PubMed
  4. Am J Transplant. 2008 Jan;8(1):86-94 - PubMed
  5. Am J Transplant. 2002 Jan;2(1):94-9 - PubMed
  6. Kidney Int. 1999 Feb;55(2):713-23 - PubMed
  7. Am J Transplant. 2004 Aug;4(8):1315-22 - PubMed
  8. Transplantation. 2003 Apr 15;75(7):971-7 - PubMed
  9. Am J Transplant. 2014 Dec;14(12):2807-13 - PubMed
  10. Am J Transplant. 2005 Jan;5(1):145-8 - PubMed
  11. Am J Surg. 2019 Jul;218(1):7-13 - PubMed
  12. Am J Transplant. 2004 Jan;4(1):101-7 - PubMed
  13. Am J Transplant. 2015 Dec;15(12):3134-42 - PubMed
  14. Transplantation. 2004 Sep 15;78(5):635-40 - PubMed
  15. Am J Transplant. 2001 Sep;1(3):296-9 - PubMed
  16. Am J Surg. 1992 Nov;164(5):541-4; discussion 544-5 - PubMed
  17. Lancet. 2019 May 18;393(10185):2059-2072 - PubMed
  18. Am J Transplant. 2016 Jan;16(1):11-20 - PubMed
  19. Am J Transplant. 2003 Aug;3(8):952-60 - PubMed
  20. Transplantation. 2008 Aug 15;86(3):474-7 - PubMed
  21. Clin Transplant. 2015 Apr;29(4):379-82 - PubMed
  22. Saudi J Kidney Dis Transpl. 2006 Sep;17(3):311-5 - PubMed
  23. Transplantation. 2017 Jun;101(6):1433-1440 - PubMed
  24. Transplantation. 2005 Jul 15;80(1):75-80 - PubMed
  25. Transplantation. 1998 Jan 27;65(2):256-60 - PubMed
  26. Transplantation. 1998 Jan 27;65(2):224-8 - PubMed
  27. Transplantation. 2006 Aug 27;82(4):479-85 - PubMed

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