ABO antibody titer and risk of antibody-mediated rejection in ABO-incompatible renal transplantation

A. A.R. Tobian, R. S. Shirey, R. A. Montgomery, W. Cai, M. Haas, P. M. Ness, K. E. King

Research output: Contribution to journalArticlepeer-review

71 Scopus citations


Therapeutic plasma exchange (TPE) preconditioning with immunosuppressive therapy reduces ABO antibody titers, permitting engraftment of ABO-incompatible (ABO-I) kidney transplants. The posttransplant predictive role of ABO antibody titers for antibody-mediated rejection (AMR) is unknown. This retrospective study evaluated 46 individuals who received TPE to permit ABO-I kidney transplantation. ABO antibody titers were performed using donor-type indicator red cells. Seven individuals (15.2%) experienced clinical or subclinical AMR. There was no significant difference between recipient blood group, number of pretransplant TPE and baseline titer between those with and without AMR. At 1-2 weeks posttransplant the median titer was 64 (range 4 - 512) among individuals with AMR and 16 (range 2 - 256) among individuals without AMR. Total agglutination reactivity score was significantly higher among individuals with AMR (p = 0.046). The risk of AMR was significantly higher among individuals with an elevated posttransplant titer of ≥64 (p = 0.006). The sensitivity of an elevated posttransplant titer was 57.1% with a specificity of 79.5%. The positive predictive value was 33.3% and the negative predictive value was 91.2%. Most individuals with AMR have an elevated titer, however, the positive predictive value of a high titer for AMR is poor.

Original languageEnglish (US)
Pages (from-to)1247-1253
Number of pages7
JournalAmerican Journal of Transplantation
Issue number5
StatePublished - May 2010


  • ABO antibodies
  • ABO incompatible
  • Antibody rebound
  • Antibody-mediated rejection (AMR)
  • Plasmapheresis
  • Renal transplantation
  • Therapeutic plasma exchange (TPE)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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