Perioperative ABO Blood Group Isoagglutinin Titer and the Risk of Acute Kidney Injury after ABO-Incompatible Living Donor Liver Transplantation

Hyeyeon Cho; Jinyoung Bae; Hyun-Kyu Yoon; Ho-Jin Lee; Seong-Mi Yang; Suk Hyung Choe; Chul-Woo Jung; Kyung-Suk Suh; Won Ho Kim

doi:10.3390/jcm10081679

Perioperative ABO Blood Group Isoagglutinin Titer and the Risk of Acute Kidney Injury after ABO-Incompatible Living Donor Liver Transplantation

J Clin Med. 2021 Apr 14;10(8):1679. doi: 10.3390/jcm10081679.

Authors

Hyeyeon Cho¹, Jinyoung Bae¹, Hyun-Kyu Yoon¹, Ho-Jin Lee¹, Seong-Mi Yang¹, Suk Hyung Choe¹, Chul-Woo Jung¹, Kyung-Suk Suh², Won Ho Kim¹

Affiliations

¹ Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-GU, Seoul 03080, Korea.
² Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-GU, Seoul 03080, Korea.

Abstract

For ABO-incompatible liver transplantation (ABO-i LT), therapeutic plasma exchange (TPE) is performed preoperatively to reduce the isoagglutinin titer of anti-ABO blood type antibodies. We evaluated whether perioperative high isoagglutinin titer is associated with postoperative risk of acute kidney injury (AKI). In 130 cases of ABO-i LT, we collected immunoglobulin (Ig) G and Ig M isoagglutinin titers of baseline, pre-LT, and postoperative peak values. These values were compared between the patients with and without postoperative AKI. Multivariable logistic regression analysis was used to evaluate the association between perioperative isoagglutinin titers and postoperative AKI. Clinical and graft-related outcomes were compared between high and low baseline and postoperative peak isoagglutinin groups. The incidence of AKI was 42.3%. Preoperative baseline and postoperative peak isoagglutinin titers of both Ig M and Ig G were significantly higher in the patients with AKI than those without AKI. Multivariable logistic regression analysis showed that preoperative baseline and postoperative peak Ig M isoagglutinin titers were significantly associated with the risk of AKI (baseline: odds ratio 1.06, 95% confidence interval 1.02 to 1.09; postoperative peak: odds ratio 1.08, 95% confidence interval 1.04 to 1.13). Cubic spline function curves show a positive relationship between the baseline and postoperative peak isoagglutinin titers and the risk of AKI. Clinical outcomes other than AKI were not significantly different according to the baseline and postoperative peak isoagglutinin titers. Preoperative high initial and postoperative peak Ig M isoagglutinin titers were significantly associated with the development of AKI. As the causal relationship between high isoagglutinin titers and risk of AKI is unclear, the high baseline and postoperative isoagglutinin titers could be used simply as a warning sign for the risk of AKI after liver transplantation.

Keywords: ABO blood-group system; acute kidney injury; anti-ABO blood type antibody; isoagglutinin; liver transplantation; living donor; therapeutic plasma exchange.