Clinical outcomes with ABO antibody titer variability in a multicenter study of ABO‐incompatible kidney transplantation in the United Kingdom

Bentall, Andrew; Barnett, Nicholas; Braitch, Manjit; Kessaris, Nicos; McKane, W S.; Newstead, Chas; McHaffie, Gavin S.; Brown, Audrey E.; Griffin, Siân; Mamode, Nizam; Briggs, David; Ball, Simon

doi:10.1111/trf.13770

Cited by 21 publications

(33 citation statements)

References 40 publications

(54 reference statements)

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“…The agreement between the DTT applied gel card titer method and the SPRCA method for both anti‐A ( κ = 0.478) and anti‐B ( κ = 0.530) was found to be better. In the study by Bentell et al, analyses of ABO antibody titers carried out at separate laboratories have shown similar agreements, with κ values ranging from 0.34 to 0.55 . Without the use of DTT, the tube titer at AHG phase interprets the total ABO antibody and not the IgG antibody.…”

Section: Discussionmentioning

confidence: 84%

“…In this context, the ABO antibody titer not only guides the feasibility of the transplant but also warrants therapies and intervening procedures prior to transplant or prevention of antibody‐mediated rejection. Studies have shown that titer measurement is crucial and may even affect the outcomes of patients undergoing ABO‐incompatible transplants . Here lies the significance of the accurate estimation of the ABO antibody titer.…”

Section: Discussionmentioning

confidence: 99%

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Comparative Evaluation of Five Different Methods of Anti‐ABO Antibody Titration: An Aid for ABO‐Incompatible Organ Transplants

et al. 2018

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The accurate estimation of ABO antibody titers is of the utmost importance in organ transplants involving ABO incompatibility. We aim to compare five different methods of titration and analyze the data. Samples of 48 O group blood donors who donated during the month of December 2015 to January 2016 in our institution were subjected to ABO antibody titration by five different methods: immediate spin (IS) tube titer, antihuman globulin phase tube titer, Coomb's gel card titer, gel card titer after dithiotreitol (DTT) treatment of plasma, and the solid phase red cell adherence method. The mean number of titer serial dilution steps in the different titer estimation methods was compared using the paired t-test and McNemar test. A correlation between the methods was tested using Spearman's rho and kappa statistics. The median antiglobulin (AHG) phase tube titers were found to be the highest anti-A (128) and anti-B (192) titers. Significant differences in the ABO antibody titer readings among the five different methods were noted. Titers were reduced by DTT treatment in nearly 50% samples tested for both anti-A and anti-B titers. Average agreements between the DTT-applied AHG phase gel card titers and the solid phase red cell adherence (SPRCA) titers was observed for anti-A (κ = 0.473) and anti-B (κ = 0.530). The AHG phase tube and gel cards titers showed poor agreements. There are differences in the interpretability of the ABO antibody titer among different techniques. Consistent and uniform application of the method for titration throughout the treatment of a patient is highly essential.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Comparative Evaluation of Five Different Methods of Anti‐ABO Antibody Titration: An Aid for ABO‐Incompatible Organ Transplants

et al. 2018

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“…While relatively inexpensive, manual dilution is both labor intensive and subjective, conferring significant interoperator variation. For this reason, differences of less than two dilutions are generally not deemed to be significant . Unless the plasma is treated with DTT before testing, the titers assessed by gel column are generally considered to reflect a combination of IgM and IgG class antibodies .…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, differences of less than two dilutions are generally not deemed to be significant. [14][15][16][17][18][19] Unless the plasma is treated with DTT before testing, the titers assessed by gel column are generally considered to reflect a combination of IgM and IgG class antibodies. 19 This is important, given that the blood bank is generally mainly concerned about the clinical effects of incompatible IgM class isoagglutinins, while transplant physicians are generally most concerned about the clinical effects of incompatible IgG class isoagglutinins.…”

Section: Discussionmentioning

confidence: 99%

Isohemagglutinin titering performed on an automated solid‐phase and hemagglutinin‐based analyzer is comparable to results obtained by manual gel testing

Lally¹,

Kruse²,

Smetana³

et al. 2020

Transfusion

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BACKGROUND Isohemagglutinins (anti‐A and anti‐B) mediate hemolytic transfusion reactions, antibody‐mediated rejection of solid‐organ transplants, and delayed engraftment after stem cell transplant. However, quantification of isohemagglutinins is often labor intensive and operator dependent, limiting availability and interfacility comparisons. We evaluated an automated, solid‐phase and agglutination‐based antibody titer platform versus manual gel testing. STUDY DESIGN AND METHODS Plasma samples were obtained from 54 randomly selected patients. Titers were determined by our laboratoryʼs standard assay (manual dilution followed by manual gel testing) and were compared to results obtained on a fully automated blood bank analyzer (Galileo NEO, Immucor). The analyzer determined immunoglobulin G (IgG) antibodies using solid‐phase and immunoglobulin M (IgM) antibodies by direct hemagglutination. RESULTS Isohemagglutinin titers obtained by manual gel versus the automated assay generally (>80%) agreed within one doubling dilution, and always (100%) agreed within two dilutions. Among O samples, the gel titer and the highest titer obtained with the automated assay (either IgG or IgM) were similar in paired, nonparametric analysis (p = 0.06 for anti‐A; p = 0.13 for anti‐B). Gel titers from group A and group B patients were slightly higher than the highest titer obtained using the automated assay (p = 0.04 for group A; p = 0.009 for group B), although these differences were within the accepted error of measurement. CONCLUSION Manual and automated methodologies yielded similar isohemagglutinin titers. Separate quantification of IgM and IgG isohemagglutinins via automated titration may yield additional insight into hemolysis, graft survival after ABO‐incompatible transplantation, and red blood cell engraftment after ABO‐incompatible stem cell transplant.

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“…Likewise, there is variation in the measurement of ABO antibodies. This is known to be considerable, 34 and ABO antibody titres were not included in the initial registry data set.…”

Section: Discussionmentioning

confidence: 99%

The UK National Registry of ABO and HLA Antibody Incompatible Renal Transplantation: Pretransplant Factors Associated With Outcome in 879 Transplants

Pankhurst

Hudson

Mumford

et al. 2017

Transplantation Direct

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BackgroundABO and HLA antibody incompatible (HLAi) renal transplants (AIT) now comprise around 10% of living donor kidney transplants. However, the relationship between pretransplant factors and medium-term outcomes are not fully understood, especially in relation to factors that may vary between centers.MethodsThe comprehensive national registry of AIT in the United Kingdom was investigated to describe the donor, recipient and transplant characteristics of AIT. Kaplan-Meier analysis was used to compare survival of AIT to all other compatible kidney transplants performed in the United Kingdom. Cox proportional hazards regression modeling was used to determine which pretransplant factors were associated with transplant survival in HLAi and ABOi separately. The primary outcome was transplant survival, taking account of death and graft failure.ResultsFor 522 HLAi and 357 ABO incompatible (ABOi) transplants, 5-year transplant survival rates were 71% (95% confidence interval [CI], 66-75%) for HLAi and 83% (95% CI, 78-87%) for ABOi, compared with 88% (95% CI, 87-89%) for 7290 standard living donor transplants, and 78% (95% CI, 77-79%) for 15 322 standard deceased donor transplants (P < 0.0001). Increased chance of transplant loss in HLAi was associated with increasing number of donor specific HLA antibodies, center performing the transplant, antibody level at the time of transplant, and an interaction between donor age and dialysis status. In ABOi, transplant loss was associated with no use of IVIg, cytomegalovirus seronegative recipient, 000 HLA donor-recipient mismatch; and increasing recipient age.ConclusionsResults of AIT were acceptable, certainly in the context of a choice between living donor AIT and an antibody compatible deceased donor transplant. Several factors were associated with increased chance of transplant loss, and these can lead to testable hypotheses for further improving therapy.

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Clinical outcomes with ABO antibody titer variability in a multicenter study of ABO‐incompatible kidney transplantation in the United Kingdom

Cited by 21 publications

References 40 publications

Comparative Evaluation of Five Different Methods of Anti‐ABO Antibody Titration: An Aid for ABO‐Incompatible Organ Transplants

Comparative Evaluation of Five Different Methods of Anti‐ABO Antibody Titration: An Aid for ABO‐Incompatible Organ Transplants

Isohemagglutinin titering performed on an automated solid‐phase and hemagglutinin‐based analyzer is comparable to results obtained by manual gel testing

The UK National Registry of ABO and HLA Antibody Incompatible Renal Transplantation: Pretransplant Factors Associated With Outcome in 879 Transplants

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