A Review of Humoral Rejection in ABO-Incompatible Kidney Transplantation, with Local (Intrarenal) DIC as the Underlying Condition

The underlying condition associated with humoral rejection in ABO-incompatible kidney transplantation is local (intrarenal) disseminated intravascular coagulation (DIC). Anti-A and anti-B antibodies adhere to blood group antigens on vascular endothelial cells, triggering antigen-antibody reactions, which cause endothelial cell injury. This, in its turn, induces the production of cytokines, migration factors, and free radicals, which activate platelets and complements, and induce thrombi, the migration of granulocytes and macrophages, and phagocytosis. As lesions progress, interstitial hemorrhage as well as necrosis and infarction due to ischemia are also caused. The degree of renal dysfunction is determined by the amount of antibodies (antibody titer), the degree of vascular endothelial injury, and the site of the lesions in blood vessels (arteries). (Fig. 1)