부산대학교 도서관

Patients receiving ABO‐incompatible (ABOi) kidney transplants are treated before and after transplant with combination therapy, such as intravenous immunoglobulin (IVIG) and therapeutic plasma exchange, to prevent allograft rejection by reducing anti‐A and anti‐B titers. Although generally considered safe, it is well known that commercial IVIGproducts contain detectable anti‐A and anti‐B, which can be associated with hemolysis. Different preparative manufacturing techniques during the production of IVIGaffect ABOantibody levels in IVIGpreparations; therefore, some manufacturers now use new methods to reduce anti‐A/B levels at the preproduction stage. The variations in implementing these strategies creates the potential for significant variation in antibody titers between products and, in some cases, even between lots of the same IVIGproduct. We report a case of persistently elevated anti‐A titers in an ABOi kidney transplant recipient associated with elevated ABOantibody titers present in the preparation of IVIGused at our facility. The authors provide evidence that the presence of anti–blood group antibodies in commercially available preparations of intravenous immunoglobulin can complicate the interpretation of anti–blood group antibody titers in the setting of incompatible organ transplantation.