@article {4419,
	title = {Transplantation of ABO A2 kidneys into O recipients: do IgM anti-A1 titers matter?.},
	journal = {Clinical transplantation//Clin Transplant},
	volume = {29},
	year = {2015},
	month = {2015},
	pages = {379 - 82},
	publisher = {Tierney,Joshua. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.},
	address = {Denmark},
	abstract = {BACKGROUND: The ABO blood subgroup A2 expresses lower levels of A antigen on the cell surface and is less immunogenic toward anti-A immunoglobulin present in blood type O or B recipients. Previous studies have shown successful kidney transplantation from A2 donors into O or B recipients with low pre-transplant anti-A titers. Previous studies suggest good results with recipient IgG titers <1:8. Few studies have specifically evaluated the importance of anti-A1 IgM titers on early outcomes following A2 to O or B kidney transplantation., METHODS: We performed a single center, retrospective review of all A2 to O living donor kidney transplants. All recipients had pre-transplant anti-A IgG titers <1:8. IgM titers were measured in all recipients and were reported but not used to determine eligibility for transplant., RESULTS: From 2001 to 2013, we performed seven consecutive A2 to O living donor kidney transplants. Early allograft dysfunction, acute rejection or thrombotic microangiopathy, occurred in four patients and were associated with high IgM titers despite low IgG titers., CONCLUSIONS: Our data show a high incidence of early acute rejection or thrombotic microangiopathy in A2 to O kidney transplants with high recipient anti-A IgM titers despite low IgG titers. Steps to lower anti-IgM pre-transplant may reduce the risk of early allograft dysfunction in A2 to O or B kidney transplants. Attention should be paid to IgM titers in establishing individual center selection criteria for A2 to B kidney transplants under the new UNOS kidney allocation system.Copyright {\textcopyright} 2015 John Wiley \& Sons A/S. Published by John Wiley \& Sons Ltd.},
	isbn = {1399-0012},
	author = {Tierney, Joshua and Shaffer, David}
}
