title: Effects of Neutralization by Soluble ABH Antigens Produced by Transplanted Kidneys From ABO-Incompatible Secretor Donors.
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.
authors.affiliation: Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jieun
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sinyoung
authors.initials: S
authors.lastname: Kim
authors.affiliation: Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: In Sik
authors.initials: IS
authors.lastname: Hwang
authors.affiliation: Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jong Rak
authors.initials: JR
authors.lastname: Choi
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.|Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae Geun
authors.initials: JG
authors.lastname: Lee
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.|Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yu Seun
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.|Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea. ysms91@yuhs.ac.
authors.forename: Myoung Soo
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea. hyunok1019@yuhs.ac.
authors.forename: Hyun Ok
authors.initials: HO
authors.lastname: Kim
mesh_terms: D000328:Adult; D001789:Blood Group Antigens / Q000276:immunology* / Q000378:metabolism; D001787:Blood Group Incompatibility / Q000276:immunology*; D003404:Creatinine / Q000097:blood; D005260:Female; D005647:Fucosyltransferases / Q000235:genetics; D005838:Genotype; D006084:Graft Rejection / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007075:Immunoglobulin M / Q000097:blood / Q000276:immunology; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D015996:Survival Rate; D014019:Tissue Donors; D014184:Transplantation, Homologous; D000097631:Galactoside 2-alpha-L-fucosyltransferase
chemical_list: D001789:Blood Group Antigens; D003404:Creatinine; D005647:Fucosyltransferases; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D000097631:Galactoside 2-alpha-L-fucosyltransferase
keywords: Blood group antigens; Blood group incompatibility; Graft survival; Kidney transplantation; β-galactoside α-1,2-fucosyltransferase