Khalili Iman, Koch Martina, Thaiss Friedrich, Plaetke Rosemarie, Bruegger Jan, Peine Sven
Clin Lab. 2017 Sep 1;63(9):1393-1401. doi: 10.7754/Clin.Lab.2017.170229.
Although the determination of the ABO antibody titers is necessary for the decision-making in ABOincompatible (ABOi) kidney transplantations, various methods for the determination of the ABO antibody titers are being used. However, the absence of uniform standards makes their comparability far more difficult. Two of the most commonly used methods are the tube method and the gel card method. In this study, we systematically investigate to what extent these two methods affect the result of ABO antibody titers.
ABO antibodies were determined from plasmas of 90 donors (30 individuals each with blood group A, B, and O). Seven further donors with blood group A, B, and AB provided erythrocytes for the testing. A total of 360 ABO antibody titers were determined; 180 tests for each method, each with 90 determinations of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody titers. In addition, we also made a differentiation by blood groups to find out if and to what extent the blood groups have an impact on the results.
Our analysis shows that the choice of method has a highly significant (p < 0.0001) impact on the titer level of the ABO antibodies. The median values of ABO antibody titers determined by using the gel card method are two titer steps lower than the titers, which are determined when using the tube method. Moreover, our data shows that there are major differences in the ABO antibody titer level among the blood groups, regardless of the choice of methods.
We consider changing to the gel card method for determining the ABO antibody titers as a simple and effective way to achieve a standardized and uniform method. Here, too, the clinicians should be provided with sufficient information by the laboratories, in order to draw the right consequence from this change, while considering all the relevant data. As a consequence of this study, the transplant center of the University of Hamburg-Eppendorf paired a change from tube to gel card regarding the ABO antibody titer determination of ABOi kidney transplantations with an intensification of the preoperative target titer from ≤ 1:8 to ≤ 1:4.
尽管ABO血型不相容（ABOi）肾移植决策时测定ABO抗体滴度很有必要，但目前测定ABO抗体滴度的方法多种多样。然而，缺乏统一标准使得这些方法的可比性大大降低。两种最常用的方法是试管法和凝胶卡法。在本研究中，我们系统地研究了这两种方法在多大程度上影响ABO抗体滴度的结果。
从90名供体（A、B、O血型各30人）的血浆中测定ABO抗体。另外7名A、B、AB血型的供体提供红细胞用于检测。共测定360个ABO抗体滴度；每种方法进行180次检测，每次检测90次免疫球蛋白G（IgG）和免疫球蛋白M（IgM）抗体滴度。此外，我们还按血型进行了区分，以了解血型是否以及在多大程度上对结果产生影响。
我们的分析表明，方法的选择对ABO抗体的滴度水平有极显著影响（p < 0.0001）。使用凝胶卡法测定的ABO抗体滴度中位数比使用试管法测定的滴度低两个滴度级别。此外，我们的数据表明，无论采用何种方法，不同血型之间的ABO抗体滴度水平存在重大差异。
我们认为改用凝胶卡法测定ABO抗体滴度是实现标准化和统一方法的一种简单有效的途径。同样，实验室应向临床医生提供充分信息，以便他们在考虑所有相关数据的情况下，从这一变化中得出正确结论。作为本研究的结果，汉堡-埃彭多夫大学移植中心在将ABOi肾移植的ABO抗体滴度测定从试管法改为凝胶卡法的同时，将术前目标滴度从≤1:8提高到≤1:4。
