Challenges in antibody titration for ABO-incompatible renal transplantation

Background and Objectives Accurate and regular monitoring of anti-A and anti-B titres pre- and post-transplantation plays a crucial role in the clinical management of patients receiving ABO-incompatible renal transplants. There is no standardized protocol or an external quality assurance program (EQA) currently available for this testing in Australia. The aim of this study was to investigate the diversity of techniques, test platforms and reagents that were currently in use in various laboratories with the aim of developing an EQA. Materials and Methods An online survey was sent to the participants enrolled with the Royal College of Pathologists of Australasia Quality Assurance Program (RCPAQAP) to assess their interest in participation in the pilot study. A total of 24 participants who expressed interest were sent the group O plasma, A(1), A(2) and B cells to perform ABO titration using their own methods. Results Participants reported a wide range of titre results, from 8 to 1024 for the anti-A titre using A(1) cells, from 2 to 128 for anti-A titre using A(2) cells and from neat to 32 for anti-B titre using B cells. Conclusion There was a wide variation in titre results between and within different technologies. These findings demonstrate the need for an ABO titration EQA. Development of a standard technique and participation in an EQA program should, over time, reduce variation and enable transferrable results across testing centres, which will assist in consistent clinical interpretation and better outcomes for patients.