Abstract
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.
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