ABO 부적합 신 이식 전 치료적 혈장교환술 횟수의 예측 변수로서의 초기 ABO 항체 역가

Abstract

Background: Therapeutic plasma exchange (TPE) for desensitization in ABO incompatible kidney transplantation (KT) has raised concerns regarding efficiency and safety. The purpose of this study was to determine the number of TPE prior to KT required to reach target titer for KT according to ABO blood groups. Methods: The distribution of ABO antibody (Ab) titer of 117 patients was investigated. The relationship between initial ABO Ab and number of TPEs required to reach target titer to ≤1:8 prior to KT was evaluated retrospectively according to blood groups and ABO Ab classes. Results: The initial IgG ABO Ab titers were the highest in blood O group recipients, and the average number± standard deviations (range) of TPEs performed prior to ABO incompatible KT was 3.0±1.1 (0∼5) in blood group A, 3.7±1.5 (0∼8) in blood group B, and 5.3±1.9 (2∼13) in blood group O, respectively. The best correlation was observed in the linear relationship between initial ABO Ab titer and number of TPEs required (y=0.6829x+ 0.0523, R2=0.946, x=log2 initial ABO Ab titer, y=number of TPE required), regardless of the specific ABO blood group. Conclusion: The number of TPEs can be highly deduced from initial ABO Ab titer and our developed equation in desensitization programs would help increase the efficiency of TPE and patient safety.