Comparing the Tube and Gel Techniques for ABO Antibody Titration, as Performed in Three European Centers

Abstract

Data from 60 consecutive ABO-incompatible kidney transplantations performed in Stockholm, Sweden; Freiburg, Germany; and Uppsala, Sweden, revealed significant variation in preoperative A/B antibody levels, with median titers of 1:32, 1:128, and 1:8, respectively. We wanted to investigate whether these differences were method-related. The same samples from 21 healthy blood donors were analyzed in the three centers using current local methods. Results confirmed method-related differences, with higher A/B titers in Freiburg and lower titers in Uppsala compared with Stockholm. Results for the same sample differed by a median of three (range 0 to 6) titer steps. When the same number of samples were analyzed in the three centers using the same gel method and the same test erythrocytes, results differed by a median of one titer step (range 0 to 4) for the same sample. In conclusion, gel hemagglutination technique significantly decreases intercenter variation compared with tube technique.

ABO‐incompatible kidney transplantation—Proposal of an intensified apheresis strategy for patients with high initial isoagglutinine titers

“…In addition to this, an extensive titer validation test was performed among the centers of Stockholm, Uppsala and Freiburg using the same samples from 21 healthy volunteers. By using the gel technique, a median deviation of only one titer step was observed between these three facilities [12].…”

ABO-Incompatible Kidney Transplantation

“…These variations seemed to be due to different techniques between laboratories, but considerable variation was still noted after standardization of techniques. Another report also showed a large variation of isoagglutinin titers (a median three-fold difference) among three centers performing ABO-I kidney transplants in Germany and Sweden (Kumlien et al, 2007). In this report, gel hemagglutination technique significantly decreased inter-center difference (a median one titer difference) compared with tube methods.…”

“…The gel or bead particles trap the RBC agglutinates as a filter during centrifugation. The agglutination is graded from 0 to 4 +, and inverted value of the highest plasma dilution that gives a 1+ agglutination reaction is interpreted as the titer (Kumlien et al, 2007).…”

A2/A2B to B Renal Transplantation: Past, Present, and Future Directions

“…One recent study tried to minimize such method variation but was only able to reduce the variation in titer testing for the AHG phase determination with the tube technique (28). Importantly, Kumlein et al (29) found that the gel hemagglutination technique significantly decreased inter-transplant center titer variation compared with the tube method. Bentall et al (30) recommended a reference method for titration with an antibody standard as a way to improve comparability of titers between transplant programs.…”