Clinical and basical research for blood group ABO-incompatible kidney transplantation.

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We planed 2 cases of ABO incompatible kidney transplantation In case 1 (recipient:blood type O, donor:blood type A) The titers of anti a antibody were reduced to x2^3 in IgM and x2^5 in IgG after splencetomy and immunoadsorption procedures for serial 3 days. However the patient could not be transplanted because of positive T cell crossmatch related with HLA antigen. In case 2 (recipient: blood type O, donor:blood type A), the titer of anti a antibody could be reduced to x2^6 in IgM and x2^5 in IgG with splenectomy, immnoadsorption plasma pheresis and plasma exchange. Such these high titers were not enough to do transplantation safely. Anti A antibody was able to be detected and separated into IgM and IgG with flowcytometry. Their reactivities of MLR and CML related with HLA were high but MRLR(Mixed red blood cell and lymphocyte culture reaction) related with a antigen were low. These results showed the different immunoresctivity between their antigens. ADCC against RBC was detected in both cases but ADCC against HLA was in only case 1 with positive T cell Cx. Under formation of antibodies against HAL and/or AB antigens, graft will be damaged by activation of complements and/or ADCC. Considering the change of reactivities of MLR and CML without antibody formation due to DST. we suspected that cellular immunity will be firstly augmented, and then antibodies will be produced. However natural antibody(IgM) and sensitized antibody(IgG) against AB antigens are always produced without activation of cellular immunity.