Methods of diagnosis and elimination of anti-A/B antibodies in AB0-incompatible kidney transplantation

Abstract

Analysis of the world literature shows that AB0-incompatible kidney transplantation is an effective method of treating patients with end-stage renal failure. However, such treatment is possible only under certain conditions. They are: determination of anti-A/B antibodies titer in the recipient’s blood and their elimination before the implantation of donor organ. Antibodies of the AB0 system — α and β are normal (natural) for humans. They belong to full antibodies — agglutinins. One of the methods for their determination is using the salt agglutination reaction. It does not require any special financial expenses, it is less accurate and takes from 4 to 6 hours to complete. Another method is microgel technology: it is more expensive, but more accurate, its performance takes less time and the test results can be saved for a long time. Several methods are used to eliminate anti-A/B antibodies. Plasmapheresis: the advantages are that, in addition to anti-A/B antibodies, other donor-specific antibodies, such as anti-HLA, are also removed in a potential recipient, and the content of the complement system proteins involved in damage to the graft is reduced in the blood. The disadvantage is that the removed plasma should be replaced, and that is possible only with donor plasma of the fourth (AB) blood group and albumin, which may cause allergic reactions, infectious complications and blood clotting disorders. Unlike plasma exchange, the method of cascade plasmapheresis allows selectively remove only the part of patient’s plasma that contains immunoglobulins. It requires less replacement volumes of donor plasma and albumin. However, the risks of this method compared to plasmapheresis remain, although to a lesser extent. The method of specific anti-A/B immunoadsorption is used with special sorbent columns. The advantages of this method of removing circulating anti-blood group antibodies are high efficiency, no need to replace the lost protein with fresh frozen plasma or albumin. However, this method requires specialized expensive equipment and does not remove anti-HLA antibodies, if any, from the recipient’s blood.