title: Clinical outcomes with ABO antibody titer variability in a multicenter study of ABO-incompatible kidney transplantation in the United Kingdom.
abstract: ABO blood group-incompatible kidney transplantation (ABOiKTx) outcomes are good, but complications are more common than in conventional transplantation. Regimens that use extracorporeal antibody removal therapy (EART) and enhanced immunosuppression are guided by titration of ABO blood group antibodies (using hemagglutination [HA] dilution assays), and these assays vary significantly in performance between centers. This study aims to describe the differences in titer measurement and the effect on clinical practice and outcomes.
  
  
  
  This multicentre, prospective cohort study of 100 ABOiKTx recipients assessed treatment and outcome data, including HA assay results measured retrospectively in a single central laboratory.
  
  
  
  Patient and allograft survival at 1 year was 99% and 94%, respectively. There were significant differences in the number of pretransplantation EART sessions in centers undertaking plasma exchange (PEx), compared with immunoadsorption (IA) (median, 6 vs. 4 sessions; p = 0.007). The pre-EART HA titer in both groups was the same when centrally assayed. The local HA assay used to guide treatment yielded significantly higher titers in centers undertaking PEx compared with IA (median, 128 vs. 32; p < 0.005). Patients undergoing PEx rather than IA were significantly more likely to suffer postoperative hematoma (12.9% vs. 1.8%; p = 0.05) or any perioperative collection requiring drainage (19.4% vs. 3.6%; p = 0.02).
  
  
  
  The colinearity of HA assay sensitivity with the receipt of PEx and EART limits some conclusions regarding the likely direction of causation. However, the association of differences in clinical practice with recognized perioperative complications of ABOiKTx identifies targets for further investigation and quality improvement.
authors: Department of Renal Medicine, Queen Elizabeth Hospital.|School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom.
authors: Andrew
authors: 0000-0002-8495-9782
authors: A
authors: Bentall
authors: Department of Transplantation, Guy's and St Thomas' Hospital, London, United Kingdom.
authors: A Nicholas
authors: AN
authors: R Barnett
authors: School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom.
authors: Manjit
authors: M
authors: Braitch
authors: Department of Transplantation, Guy's and St Thomas' Hospital, London, United Kingdom.
authors: Nicos
authors: N
authors: Kessaris
authors: Sheffield Kidney Institute, Sheffield Teaching Hospitals, Sheffield, United Kingdom.
authors: Will
authors: W
authors: McKane
authors: Department of Nephrology and Transplantation, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom.
authors: Chas
authors: C
authors: Newstead
authors: Department of Nephrology and Transplantation, Nottingham, United Kingdom.
authors: Gavin
authors: G
authors: McHaffie
authors: Department of Nephrology and Transplantation, Newcastle, United Kingdom.
authors: Alison
authors: A
authors: Brown
authors: Department of Nephrology and Transplantation, Cardiff, United Kingdom.
authors: Sian
authors: S
authors: Griffin
authors: Department of Transplantation, Guy's and St Thomas' Hospital, London, United Kingdom.
authors: Nizam
authors: N
authors: Mamode
authors: Department of Histocompatibility and Immunogenetics, National Health Service Blood and Transplant, Birmingham Centre, Birmingham, United Kingdom.
authors: David
authors: D
authors: Briggs
authors: Department of Renal Medicine, Queen Elizabeth Hospital.|School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom.
authors: Simon
authors: S
authors: Ball
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000906:Antibodies / Q000097:blood / Q000302:isolation & purification*; D001787:Blood Group Incompatibility / Q000276:immunology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007163:Immunosorbent Techniques / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000009:adverse effects; D011446:Prospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000017:ABO Blood-Group System; D000906:Antibodies