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Updated: Jan 9, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Long-Term Clinical Outcomes of ABO-Incompatible Kidney Transplantation in Patients With High Baseline Anti-A/B
Sang Hun Eum1,2, Hanbi Lee2,3, Eun Jeong Ko2,4
1Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Background:
This study aimed to investigate the long-term clinical outcomes of ABO-incompatible kidney transplantation (ABO icKT) in patients with high baseline anti-A/B antibody titers.
Methods:
This study included 271 cases of ABO icKT. Of these, 42 patients with a baseline antibody titer of ≥ 1:256 were assigned to the high-titer group, while the remaining 229 patients were categorized into the low-titer group. We compared the groups regarding the number of required pre-transplant plasmapheresis (PP) and intravenous immunoglobulin (IVIG) sessions. Clinical outcomes included post-operative bleeding, biopsy-proven acute rejection (BPAR), infectious complications, changes in allograft function, and long-term allograft and patient survival.
Results:
The high-titer group required significantly more sessions of PP and IVIG than the low-titer group (8.74 ± 2.68 vs. 3.85 ± 1.64; P < 0.001). Following transplantation, anti-A/B antibody titers remained elevated in the high-titer group. There was no significant difference in post-operative bleeding between the two groups. However, the incidence of bacterial infection was higher in the high-titer group compared with the low-titer group (47.62% vs. 30.57%; P = 0.031), although this association was not significant in multivariable analysis. The incidence of total BPAR did not differ significantly; however, chronic active antibody-mediated rejection was more frequently observed in the high-titer group (7.14% vs. 0.87%; P = 0.028). Overall allograft and patient survival did not differ significantly between the two groups.
Conclusion:
Patients with high baseline anti-A/B titers demonstrated comparable short-term and long-term patient and allograft outcomes to those in the low-titer group.
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