Research of the regulation pf acute allograft rejection in ABO-blood type incompatible kidney transplantation

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ABO-blood type incompatible kidney transplantation is one of a big challenge to overcome the immunological barrier of humoral rejection caused by acquired natural antibodies. In this study we have achieved "the state of the art" today and published the books entitled "ABO incompatible kidney transplantation". In the article, head investigator Takahashi described about the history, patient and graft survival data update in Japan, antigenic molecules and antibodies, indication and peri-dperacive evaluation and management, immunosuppression, extra-corporeal immuno-modulation, standard operative methods of transplantation and splenectomy, infection control, clinico-pathological research and case reports, and future perspectives. In the article, we also present a new strategy of pathological croteria for allograft rejection in ABO-incompatible kidney transplantation.In addition, in order to evaluate pre-sensitization status and high risk group for acute rejection in kidney transplantation, we have developed cellular ELISA system to detect anti glomerular endothehal cell antibodies(AECA-GEC) and anti-human umbilical vein endothelial cells(AECA-HUVEG) in kidney transplant recipient serum.In the sequential serum examination in 22 recipients, AECA-GEC positive group showed significantly high frequency, of acute rejection.episodes This phenomena suggests that AECA-GEC positive status may indicate pre-sensitization status against organ-specific antigens expressed on renal glomerular endothelial cells which might cause the disturbance of microcirculation of the graft leading to acute humoral and cellular rejection.We also provide a possibility of an new strategy of immunosuppressive therapy including elimination of acquired antibodies and continuous immunosuppression of antibody production by lymphocytes in highly sensitized recipients.