Distribution of Anti-ABO Immunoglobulin G Subclass and C1q Antibody in ABO Incompatible Kidney Transplantation

Abstract

Introduction To investigate the correlation between serum anti-ABO immunoglobulin G (IgG) and IgG subtypes, anti-ABO IgG subclasses were measured by flow cytometry (FCM) in ABO-incompatible (ABO-i) kidney transplant recipients (KTRs). We also evaluated baseline anti-ABO C1q antibody of KTRs. Method Baseline anti-ABO IgG titers were measured with both FCM and column agglutination technique (CAT) methods in 18 ABO-i KTRs. The mean florescence intensity (MFI) ratios of baseline Anti-ABO IgG subclasses were obtained by FCM method and followed up after rituximab (RTX), each plasmapheresis (PP) session and kidney transplantation. Correlation between the values of IgG subclass and total IgG titer were analyzed. Baseline anti-ABO C1q antibody was measured by FCM methods. Result The baseline MFI ratios of total IgG, IgG1, IgG2, IgG3 and IgG4 were 202.46, 62.41, 30.01, 1.04 and 1.13, respectively. The MFI ratios of IgG1, IgG2, and total IgG measured at baseline and pre-PP were positively correlated with the baseline ABO titer measured by CAT (rho, baseline; 0.641, 0.638, 0.663, PP; 0.662, 0.581, 0.662). However, Spearman correlation analysis revealed that baseline ABO titer did not show any correlation with the values after final PP and transplantation. IgG1 and IgG2 as well as total IgG were removed effectively after serial PP. However, anti-ABO C1q antibody was not detected and neither correlated with total IgG and any IgG subclasses. Conclusion Our findings suggest that IgG1 and IgG2 are dominant IgG subtypes in ABO-i KTRs. The mean baseline levels of IgG1 and IgG2 were correlated with baseline total IgG titer. However, anti-ABO C1q antibody was not detected in the present study. Further study is warranted to evaluate the function of each IgG subtype to activate complement pathway.