Effect of initial blood group antibody titer on renal function and immune function in ABO blood type-incompatible live renal transplant receptors

doi:10.3877/cma.j.issn.1674-0785.2022.10.015

Abstract

Abstract:

Objective

To investigate the effect of the initial blood group antibody titer before renal transplantation on the postoperative renal function and immune function in ABO blood type-incompatible living donor kidney transplant recipients.

Methods

A total of 91 patients who received living donor kidney transplantation at Anhui Provincial Hospital from July 2019 to June 2021 were selected. ABO blood types were incompatible between all kidney transplant donors and recipients. According to the blood group antibody immunoglobulin (Ig)M titer levels of the patients at admission, they were divided into either a high titer group (IgM≥128) or a low titer group (IgM＜128). All patients were treated by double filtration plasmapheresis before surgery and then underwent living donor kidney transplantation. Changes of blood group antibody, renal function, cellular immunity, and humoral immunity after operation were compared between the two groups.

Results

There was no significant difference in the levels of blood group antibody IgM or IgG titers at days 1, 3, and 7 after operation, and at the time of discharge between the two groups (P＞0.05). Creatinine at days 3 and 7 and at discharge were significantly lower than that at day 1 in both groups (P＜0.05), while glomerular filtration rate at days 3 and 7 and at discharge were significantly higher than that at day 1 (P＜0.05); there was no statistical difference between the two groups (P＞0.05). The levels of CD3⁺ T cells, CD4⁺ T cells, CD4⁺/CD8⁺ ratio, and NK cells were significantly higher at day 7 and at discharge than at day 1, and at discharge than at day 3 in both groups (P＜0.05); there was no statistical difference between the two groups (P＞0.05). The levels of IgG, IgA, IgG , C3, and C4 were significantly higher at day 7 and at discharge than at day 1, and at discharge than at day 3 in both groups; the levels of these indexes at discharge were significantly higher in the high titer group higher than in the low titer group (P＜0.05).

Conclusion

The initial blood group antibody titer of ABO incompatible living donor kidney transplant recipients has no significant effect on the renal function and cellular immune function of the patients, but the humoral immunity level of patients with a high titer is higher after surgery.

Key words: Blood type antibody, ABO blood type incompatibility, Kidney transplantation, Renal function, Immune function

Cheng Qiu, Shuai Dai, Lexi Zhang, Hongtao Liu. Effect of initial blood group antibody titer on renal function and immune function in ABO blood type-incompatible live renal transplant receptors[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(10): 1005-1011.

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Figures/Tables 6

因素	低效价（n=57）	高效价（n=29）	t/Z值	P值
年龄（岁， $x ¯$ ±s）	34.48±7.35	32.56±6.39	1.195	0.235
性别［例］			1.337	0.247
男性	44	19
女性	13	10
受供血型			2.084	0.149
A-B	29	10
B-A	28	19
体质量指数（kg/m²， $x ¯$ ±s）	21.65±2.21	20.71±3.64	1.488	0.141
透析时间（月， $x ¯$ ±s）	12.16±8.05	12.98±22.30	0.675	0.529
术前肌酐（mmol/L， $x ¯$ ±s）	978.72±261.39	1004.20±329.52	0.391	0.697
HLA错配（0~8）	3.24±1.46	3.31±1.18	0.224	0.824
热缺血时间（s， $x ¯$ ±s）	202.03±43.87	188.94±37.27	1.373	0.173
供肾重量（g， $x ¯$ ±s）	158.92±17.57	167.88±34.82	1.591	0.115
术前透析方式［例］			0.369	0.543
血液透析	31	17
腹膜透析	21	8
未透析	5	4
原发病［例］			0.078	0.780
慢性肾小球肾炎	25	13
局灶节段性肾小球硬化	12	6
IgA肾病	13	7
不详或其他	7	3
预处理次数（次， $x ¯$ ±s）	3.14±1.59	5.62±2.29	5.876	＜0.001
血型抗体IgM	32（8~32）	256（128~512）	7.629	＜0.001
血型抗体IgG	16（4~32）	512（48~1024）	5.133	＜0.001

因素	低效价（n=57）	高效价（n=29）	t/Z值	P值
年龄（岁， $x ¯$ ±s）	34.48±7.35	32.56±6.39	1.195	0.235
性别［例］			1.337	0.247
男性	44	19
女性	13	10
受供血型			2.084	0.149
A-B	29	10
B-A	28	19
体质量指数（kg/m²， $x ¯$ ±s）	21.65±2.21	20.71±3.64	1.488	0.141
透析时间（月， $x ¯$ ±s）	12.16±8.05	12.98±22.30	0.675	0.529
术前肌酐（mmol/L， $x ¯$ ±s）	978.72±261.39	1004.20±329.52	0.391	0.697
HLA错配（0~8）	3.24±1.46	3.31±1.18	0.224	0.824
热缺血时间（s， $x ¯$ ±s）	202.03±43.87	188.94±37.27	1.373	0.173
供肾重量（g， $x ¯$ ±s）	158.92±17.57	167.88±34.82	1.591	0.115
术前透析方式［例］			0.369	0.543
血液透析	31	17
腹膜透析	21	8
未透析	5	4
原发病［例］			0.078	0.780
慢性肾小球肾炎	25	13
局灶节段性肾小球硬化	12	6
IgA肾病	13	7
不详或其他	7	3
预处理次数（次， $x ¯$ ±s）	3.14±1.59	5.62±2.29	5.876	＜0.001
血型抗体IgM	32（8~32）	256（128~512）	7.629	＜0.001
血型抗体IgG	16（4~32）	512（48~1024）	5.133	＜0.001

因素	例数	术后第1天	术后第3天	术后第7天	出院时
肌酐（mmol/L）
低效价组	57	405.02±185.56	124.39±62.14^a	98.89±42.69^a	96.65±40.59^a
高效价组	29	346.69±156.75	121.86±46.65^a	95.62±35.86^a	94.03±34.59^a
t值		1.449	0.193	0.354	0.296
P值		0.151	0.848	0.724	0.768
肾小球滤过率（ml/min）
低效价组	57	47.62±20.64	60.89±28.29^a	58.76±30.29^a	52.56±22.32^a
高效价组	29	51.23±24.32	64.76±26.20^a	60.14±21.13^a	59.33±21.11^a
t值		0.722	0.614	0.219	1.354
P值		0.473	0.541	0.827	0.179

因素	例数	术后第1天	术后第3天	术后第7天	出院时
CD3
低效价组	57	54.39±4.85	55.97±4.84	57.07±4.87^a	58.21±5.29^ab
高效价组	29	53.68±4.62	56.07±4.72	58.04±4.52^a	59.94±5.49^ab
t值		0.652	0.091	0.894	1.416
P值		0.516	0.927	0.374	0.161
CD4
低效价组	57	28.87±2.46	31.94±2.61	34.71±3.01^a	37.27±3.29^ab
高效价组	29	28.83±2.71	31.83±2.84	33.80±3.13^a	37.93±3.48^ab
t值		0.069	0.179	1.308	0.863
P值		0.945	0.858	0.194	0.391
CD4/CD8
低效价组	57	1.28±0.70	1.29±0.76	1.36±0.79^a	1.37±0.52^ab
高效价组	29	1.24±0.55	1.27±0.63	1.29±0.11^a	1.31±0.46^ab
t值		0.268	0.122	0.473	0.525
P值		0.789	0.903	0.637	0.601
NK细胞
低效价组	57	6.86±3.11	8.14±3.32	9.88±3.63^a	11.76±3.99^ab
高效价组	29	6.96±3.29	8.43±3.44	10.10±3.86^a	12.24±4.27^ab
t值		0.138	0.378	0.260	0.515
P值		0.890	0.706	0.795	0.608

因素	例数	术后第1天	术后第3天	术后第7天	出院时
IgG（g/L）
低效价组	57	6.85±0.77	7.19±1.02	8.33±1.22^a	9.48±1.23^ab
高效价组	29	6.91±0.79	7.42±1.09	8.98±1.29^a	10.53±1.38^ab
t值		0.339	0.966	2.291	3.591
P值		0.736	0.337	0.024	0.001
IgA（mg/L）
低效价组	57	1208.75±213.23	1305.64±302.16	1456.69±352.35^a	1621.54±375.14^ab
高效价组	29	1243.72±237.28	1385.58±352.19	1636.74±422.36^a	1877.31±395.13^ab
t值		0.692	1.096	2.093	2.936
P值		0.491	0.276	0.039	0.004
IgM（mg/L）
低效价组	57	620.46±310.16	820.73±320.53	1009.18±372.25^a	1227.56±403.82^ab
高效价组	29	650.49±340.16	910.75±364.51	1186.92±392.57^a	1492.55±440.74^ab
t值		0.411	1.175	2.055	2.789
P值		0.682	0.243	0.043	0.007
C3（g/L）
低效价组	57	0.67±0.12	0.71±0.14	0.74±0.14^a	0.79±0.14^ab
高效价组	29	0.68±0.13	0.73±0.15	0.78±0.13^a	0.86±0.13^ab
t值		0.355	0.611	1.282	2.244
P值		0.723	0.543	0.203	0.027
C4（g/L）
低效价组	57	0.22±0.05	0.25±0.06	0.28±0.06^a	0.32±0.08^ab
高效价组	29	0.23±0.06	0.27±0.07	0.31±0.08^a	0.36±0.08^ab
t值		0.819	1.381	1.953	2.192
P值		0.415	0.171	0.054	0.031

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