title: Anti-Blood Group Antibodies in Intravenous Immunoglobulin May Complicate Interpretation of Antibody Titers in ABO-Incompatible Transplantation.
abstract: Patients receiving ABO-incompatible (ABOi) kidney transplants are treated before and after transplant with combination therapy, such as intravenous immunoglobulin (IVIG) and therapeutic plasma exchange, to prevent allograft rejection by reducing anti-A and anti-B titers. Although generally considered safe, it is well known that commercial IVIG products contain detectable anti-A and anti-B, which can be associated with hemolysis. Different preparative manufacturing techniques during the production of IVIG affect ABO antibody levels in IVIG preparations; therefore, some manufacturers now use new methods to reduce anti-A/B levels at the preproduction stage. The variations in implementing these strategies creates the potential for significant variation in antibody titers between products and, in some cases, even between lots of the same IVIG product. We report a case of persistently elevated anti-A titers in an ABOi kidney transplant recipient associated with elevated ABO antibody titers present in the preparation of IVIG used at our facility.
authors.affiliation: Department of Pathology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: E M
authors.identifier: 0000-0001-9567-4013
authors.initials: EM
authors.lastname: Staley
authors.affiliation: Pharmacy Department, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: S S
authors.initials: SS
authors.lastname: Carruba
authors.affiliation: Pharmacy Department, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: M
authors.initials: M
authors.lastname: Manning
authors.affiliation: Department of Pathology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: H P
authors.initials: HP
authors.lastname: Pham
authors.affiliation: Department of Pathology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: L A
authors.initials: LA
authors.lastname: Williams
authors.affiliation: Department of Pathology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: M B
authors.initials: MB
authors.lastname: Marques
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: J E
authors.initials: JE
authors.lastname: Locke
authors.affiliation: Department of Pathology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: R G
authors.initials: RG
authors.lastname: Lorenz
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology*; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000276:immunology*; D007518:Isoantibodies / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D010956:Plasmapheresis; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors
chemical_list: D000017:ABO Blood-Group System; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies
keywords: ABO incompatibility; clinical research/practice; kidney transplantation/nephrology; monitoring: immune