A Cautionary Tale: ABO Genotyping in Kidney Transplantation of ABO A2 Kidneys Into B or O Recipients

IF 5.9 4区医学 Q2 CELL BIOLOGY

HLA Pub Date : 2025-02-11 DOI:10.1111/tan.70081

Cathi L. Murphey, Amanda Bailey, Matthias Kapturczak, Howard M. Gebel, Robert A. Bray

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Abstract

The US 2014 kidney allocation system (KAS) allows ABO A₂ donor kidneys to be transplanted into ABO B candidates, thereby broadening the donor pool for a traditionally disadvantaged population. Safely transplanting these patients relies heavily on two components: (1) recipient ABO antibody titres and (2) ABO A subtyping of the donor. While lectin-based serological methods remain the gold standard for ABO typing, recent data show ABO molecular genotyping is a more reliable approach to accurately assign the A₂ subtype. ABO titres were performed using Ortho Diagnostics gel cards using haemagglutination by both antiglobulin-enhanced and dithiothreitol methods. ABO genotyping was performed using innotrain diagnostiks Real-Time PCR. Here, we present two cases where ABO lectin testing incorrectly identified the donors as ABO A₂ and A₂B instead of A₁ and A₁B. Consequently, the transplants proceeded but had deleterious outcomes. These two cases support the concept that ABO genotyping by molecular methodology should be mandatory to confirm the A₂ donor subtype when transplanting kidneys from deceased donors into ABO B candidates on the waitlist and for virtual crossmatching (VXM) donors being considered for transplantation into ABO B and O recipients.

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来源期刊

HLA Immunology and Microbiology-Immunology

CiteScore

3.00

自引率

28.80%

发文量

368

期刊介绍： HLA, the journal, publishes articles on various aspects of immunogenetics. These include the immunogenetics of cell surface antigens, the ontogeny and phylogeny of the immune system, the immunogenetics of cell interactions, the functional aspects of cell surface molecules and their natural ligands, and the role of tissue antigens in immune reactions. Additionally, the journal covers experimental and clinical transplantation, the relationships between normal tissue antigens and tumor-associated antigens, the genetic control of immune response and disease susceptibility, and the biochemistry and molecular biology of alloantigens and leukocyte differentiation. Manuscripts on molecules expressed on lymphoid cells, myeloid cells, platelets, and non-lineage-restricted antigens are welcomed. Lastly, the journal focuses on the immunogenetics of histocompatibility antigens in both humans and experimental animals, including their tissue distribution, regulation, and expression in normal and malignant cells, as well as the use of antigens as markers for disease.