A perspective on ABO incompatible transplantation

Area of Science:

• Immunology
• Transplantation Science
• Clinical Chemistry

Background:

• ABO blood group compatibility is vital for solid organ and stem cell transplants.
• ABO-incompatible (ABOi) transplantation faces risks like antibody-mediated rejection (ABMR) due to recipient antibodies binding donor antigens.
• Isohaemagglutinin measurement via antibody titration is essential for assessing transplant suitability and guiding desensitization.

Purpose of the Study:

• To review current laboratory challenges in ABO antibody titration.
• To discuss alternative and evolving analytical approaches for ABO antibody assessment.
• To explore future directions for improving ABO antibody testing reliability in ABOi transplantation.

Main Methods:

• Review of existing literature on ABO antibody titration methodologies.
• Analysis of inter-laboratory variability stemming from diverse assay platforms and techniques.
• Discussion of alternative methods like flow cytometry, solid-phase assays, and complement-binding tests.

Main Results:

• Significant inter-laboratory variability exists in ABO antibody titration due to non-standardized methods.
• Methodological variations, interpretation of titres, and biological factors impact antibody expression and measurement.
• Current titration methods can influence transplant eligibility and patient outcomes.

Conclusions:

• Lack of international standardization in ABO antibody titration is a major limitation.
• Standardization, improved risk stratification, and novel technologies are needed for reliable ABO antibody assessment.
• International collaboration is essential to enhance ABO antibody testing and improve outcomes in ABOi transplantation.