1
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Abraha J, Rao P, Morris GP. Modes of assay interference and the effectiveness of serum pretreatment approaches in detection of anti-HLA antibodies. J Clin Pathol 2024; 77:284-290. [PMID: 36600574 DOI: 10.1136/jcp-2022-208371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
AIMS Several modes of assay interference common to immunoassays affect solid-phase single-antigen bead-based immunoassays (SAB) used to detect antibodies against human leucocyte antigens (HLA). Best practice recommendations include methods to address assay interference, though the clinical impact and optimal approaches are undefined. We sought to evaluate assay interference in HLA SAB to identify an efficient approach for avoiding erroneous results. METHODS Retrospective analysis of 14 059 patient samples tested for anti-HLA antibodies was performed. This included 4685 samples tested prior to implementation of serum pretreatment with EDTA and 4982 samples tested with routine EDTA treatment using the same testing algorithm. An algorithm for efficiently identifying and processing samples with suspected interference was evaluated in a separate cohort of 4392 EDTA-treated samples. RESULTS EDTA serum pretreatment reduced assay interference, but did not eliminate all modes of interference. A protocol for identification and testing of samples with suspected interference facilitated efficient detection of interference while reducing the amount of additional testing required. CONCLUSIONS Our data indicate that a single-method approach is insufficient to address all sources of interference in HLA SAB. A multimodal approach with a proactive screening is a more effective way to minimise risk of erroneous results.
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Affiliation(s)
- Joseph Abraha
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Ping Rao
- Aurora Health Care, Milwaukee, Wisconsin, USA
| | - Gerald P Morris
- Department of Pathology, University of California San Diego, La Jolla, California, USA
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2
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Dahmani M, Zhu JC, Cook JH, Riley SP. Anaphylatoxin signaling activates macrophages to control intracellular Rickettsia proliferation. Microbiol Spectr 2023; 11:e0253823. [PMID: 37855623 PMCID: PMC10714731 DOI: 10.1128/spectrum.02538-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023] Open
Abstract
IMPORTANCE Pathogenic Rickettsia species are extremely dangerous bacteria that grow within the cytoplasm of host mammalian cells. In most cases, these bacteria are able to overpower the host cell and grow within the protected environment of the cytoplasm. However, a dramatic conflict occurs when Rickettsia encounter innate immune cells; the bacteria can "win" by taking over the host, or the bacteria can "lose" if the host cell efficiently fights the infection. This manuscript examines how the immune complement system is able to detect the presence of Rickettsia and alert nearby cells. Byproducts of complement activation called anaphylatoxins are signals that "activate" innate immune cells to mount an aggressive defensive strategy. This study enhances our collective understanding of the innate immune reaction to intracellular bacteria and will contribute to future efforts at controlling these dangerous infections.
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Affiliation(s)
- Mustapha Dahmani
- Department of Veterinary Medicine, University of Maryland-College Park, College Park, Maryland, USA
| | - Jinyi C. Zhu
- Department of Veterinary Medicine, University of Maryland-College Park, College Park, Maryland, USA
| | - Jack H. Cook
- Department of Veterinary Medicine, University of Maryland-College Park, College Park, Maryland, USA
| | - Sean P. Riley
- Department of Veterinary Medicine, University of Maryland-College Park, College Park, Maryland, USA
- Virginia-Maryland College of Veterinary Medicine, College Park, Maryland, USA
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3
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Roa-Bautista A, López-Del-Moral C, González-López E, Gutiérrez-Larrañaga M, Renuncio-García M, Castro-Hernández C, Mikhalkovich-Mikhalkovich D, Comins-Boo A, Irure-Ventura J, Rodrigo E, Ruiz San Millán JC, López-Hoyos M, San Segundo D. Non-HLA Antibodies and Their Role in Highly Sensitized Patients. Transplant Proc 2022; 54:2439-2442. [PMID: 36319497 DOI: 10.1016/j.transproceed.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/20/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The role of non-HLA antibody is gaining special attention in solid-organ transplantation and in highly sensitized (HS) patients because of its potential involvement in graft loss (GL) and/or antibody-mediated rejection (ABMR). The identification of non-HLA antibodies while listed may provide deeper information about the increased immunologic risk prior to transplant. We aimed to identify non-HLA antibodies pretransplant that could involve GL in HS patients. METHODS Nineteen pretransplant samples from HS patients who underwent transplant at the Marqués de Valdecilla University Hospital were studied for both HLA antibodies and a panel of 39 non-HLA antigens analyzed based on Luminex platform. RESULTS Eleven patient (57.9%) maintained the graft (KT group), whereas 8 (42.1%) had a GL within a median of 30 days. The median fluorescent intensity (MFI) of the 39 non-HLA antigens were compared within the groups, obtaining a statistically significant differences in protein tyrosine phosphatase receptor type N (P < .04) with a MFI mean of 1408 vs 4931 for KT and GL groups, respectively. However, no significant differences were observed in non-HLA MFI between ABMR and non-ABMR KT recipients. CONCLUSIONS The presence of non-HLA antibodies in HS is high. The levels of anti-protein tyrosine phosphatase receptor type N before transplant could indicate a potential risk of GL, although longitudinal studies with large number of cases are needed to define anti-non-HLA profiles of risk of ABMR.
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Affiliation(s)
- Adriel Roa-Bautista
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | | | - Elena González-López
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - María Gutiérrez-Larrañaga
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Mónica Renuncio-García
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Carolina Castro-Hernández
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Dzmitry Mikhalkovich-Mikhalkovich
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Alejandra Comins-Boo
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Juan Irure-Ventura
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Emilio Rodrigo
- Nephrology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | - Marcos López-Hoyos
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - David San Segundo
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain.
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4
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Singh P, Tiwari AK, Mishra VC, Deshpande TV, Dorwal P, Bhardwaj AK, Kumari S, Raina V. Prozone phenomenon in pretransplant testing: An interesting conundrum involving solid-phase and cell-based assays. Asian J Transfus Sci 2022; 16:180-185. [PMID: 36687549 PMCID: PMC9855212 DOI: 10.4103/ajts.ajts_145_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 05/16/2021] [Accepted: 06/22/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Human leukocyte antigen (HLA) is a major determinant in deciding upon solid organ histocompatibility. Donor-specific anti-HLA antibodies (Donor-specific anti-HLA antibodies (DSAs)) are always a contraindication for solid organ transplantation, and identification of DSA becomes very crucial before transplantation to provide long-term graft survival. For identification of DSA, usually, either cell-based or HLA bead-based assay is being used in laboratories. However, both cell-based and bead-based assays have certain limitations. One such common limitation is "prozone effect," which can give false-negative results. Here, we would like to present a small pilot study to analyze the effect of the prozone phenomenon in the cell-based and HLA bead-based assays and its utility in histocompatibility testing. MATERIALS AND METHODS In a series of four experiments, cell-based assay, flow cytometric cross-match (FCXM), and HLA bead-based flow cytometric panel reactive antibodies (PRAs) were performed. Single-antigen bead (SAB) testing was conducted as a first experiment on four known positives samples for anti-HLA antibody-antibodies. In the second experiment, these four samples were pooled together (called pooled sera in the text) and tested for FCXM and PRA. In the third experiment, known commercially available positive control sera were mixed with pooled positive sera (positive control sera + pooled sera) to prepare, what we have called "positive concoction" in the text. In the fourth experiment, the positive concoction was diluted serially (1:2, 1:4, 1:8, and 1:16) and FCXM and PRA were performed again to analyze and compare the prozone effect. RESULTS Pooled sera did not have the expected median fluorescence intensity (MFI) values in FCXM assay, whereas the PRA was showing >90% positivity. In positive concoction, the MFI of FCXM assay was observed to be declining; however, PRA values remained almost constant. Dilutions of the pooled sera showed that MFI values of FCXM assays were increased suddenly after dilution. The highest MFI values were observed in 1:4 dilution of the sera, and then, it declined gradually, but the PRA values remained almost constant even after serial dilutions. CONCLUSION In our experimental findings, it was clear that cell-based assay (FCXM) was more severely affected by the prozone, whereas solid-phase (flow PRA) assay remained resistant to prozone.
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Affiliation(s)
- Parvind Singh
- Department of Transplant Immunology, Chimera Transplant Research Foundation, New Delhi, India
| | - Aseem Kumar Tiwari
- Department of Transfusion Medicine, Medanta – The Medicity, Gurugram, Haryana, India
| | - Vikash Chandra Mishra
- Department of Transplant Immunology, Chimera Transplant Research Foundation, New Delhi, India
| | | | - Pranav Dorwal
- Department of Flowcytometry, Waikato Hospital, Hamilton, New Zealand
| | - Amit Kr Bhardwaj
- Department of Transplant Immunology, Chimera Transplant Research Foundation, New Delhi, India
| | - Sneha Kumari
- Department of Transplant Immunology, Chimera Transplant Research Foundation, New Delhi, India
| | - Vimarsh Raina
- Department of Transplant Immunology, Chimera Transplant Research Foundation, New Delhi, India
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5
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Devriese M, Hays C, Jouffrey J, Usureau C, Carmagnat M, Caillat-Zucman S, Taupin JL. Deciphering the role of the conjugate's phycoerythrin label in complement-mediated interference occurring in HLA single antigen Luminex bead assays. HLA 2022; 99:573-579. [PMID: 35411722 DOI: 10.1111/tan.14628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/19/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
Complement-mediated interference is a well described phenomenon in single antigen bead (SAB) Luminex assay that leads to falsely low or negative results for anti-HLA antibody (Ab). In a context of high amount of Ab, the enrichment of the Ab around the bead can lead to complement cascade activation and deposition, thereafter impairing Ab detection. EDTA is now routinely used to circumvent this interference. In this report, we attempted to decipher the role of the phycoerythrin (PE) label conjugated to the secondary Ab in this interference. Indeed, PE is a huge molecule (240 kDa) that could participate to limiting access of the conjugate to its Ab target on the bead. To this purpose, 22 sera displaying complement interference without pre-treatment with EDTA were compared on SAB assay with three detection strategies: the recommended PE-conjugated secondary Ab (IgGPE), an Alexa Fluor 532-conjugated Ab (IgGAF) bearing a tiny 724 Da fluorochrome, and a biotinylated Ab followed by PE-conjugated streptavidin (IgGBiot). Complement interference occurred with the three detection methods, but its depth, defined by the percentage of MFI loss with neat serum, was the highest for IgGPE. Our study highlighted the partial role of the PE fluorochrome in complement interference in SAB assays.
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Affiliation(s)
- Magali Devriese
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint Louis, Paris, France.,INSERM UMR976, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Constantin Hays
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint Louis, Paris, France.,INSERM UMR976, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Julie Jouffrey
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint Louis, Paris, France
| | - Cédric Usureau
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint Louis, Paris, France
| | | | - Sophie Caillat-Zucman
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint Louis, Paris, France.,INSERM UMR976, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Jean Luc Taupin
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint Louis, Paris, France.,INSERM UMR976, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
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6
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Xu Q, Sood P, Helmick D, Lomago JS, Tevar AD, Zeevi A. Positive flow cytometry crossmatch with discrepant antibody testing results following COVID-19 vaccination. Am J Transplant 2021; 21:3785-3789. [PMID: 34241963 PMCID: PMC8441686 DOI: 10.1111/ajt.16753] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 01/25/2023]
Abstract
The impact of COVID-19 vaccination on the alloimmunity of transplant candidates is unknown. We report a case of positive B cell flow cytometry crossmatch in a patient waiting for second kidney transplantation, 37 days after receiving the COVID-19 vaccine. The preliminary crossmatch, using sample collected before COVID-19 vaccination, was negative. The antibodies to mismatched donor HLA-DR7 were detected only with multi-antigen beads but not with single-antigen beads, excluding possible prozone effects in solid-phase antibody assays. The crossmatches were positive with HLA-DR7-positive surrogates (n = 2) while negative with HLA-DR7-negative surrogates (n = 3), which confirms the HLA-DR7 alloreactivity. The antigen configurations on B lymphocytes are similar to that on the multi-antigen beads while distinct from the single-antigen beads. HLA-DR7 was the repeating mismatched antigen with the failing first kidney allograft. The newly emerged antibody to HLA-DR7 probably is the consequence of bystander activation of memory response by the COVID-19 vaccination. This case highlights the importance of verifying allo-sensitization history and utilizing multiple assays, including cell-based crossmatch and solid-phase assays with multi-antigens. COVID-19 immunization may deserve special attention when assessing the immunological risk before and after organ transplantation.
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Affiliation(s)
- Qingyong Xu
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA,Correspondence Qingyong Xu, Department of Pathology, University of Pittsburgh Medical Center, UPMC-Clinical Lab Building, Pittsburgh, PA, USA.
| | - Puneet Sood
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dennis Helmick
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jon S. Lomago
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amit D. Tevar
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA,Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Adriana Zeevi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA,Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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7
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Bayoumy S, Martiskainen I, Heikkilä T, Rautanen C, Hedberg P, Hyytiä H, Wittfooth S, Pettersson K. Sensitive and quantitative detection of cardiac troponin I with upconverting nanoparticle lateral flow test with minimized interference. Sci Rep 2021; 11:18698. [PMID: 34548577 PMCID: PMC8455528 DOI: 10.1038/s41598-021-98199-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/06/2021] [Indexed: 01/09/2023] Open
Abstract
Measurement of cardiac troponin I (cTnI) should be feasible for point-of-care testing (POCT) to diagnose acute myocardial infarction (AMI). Lateral flow immunoassays (LFIAs) have been long implemented in POCT and clinical settings. However, sensitivity, matrix effect and quantitation in lateral flow immunoassays (LFIAs) have been major limiting factors. The performance of LFIAs can be improved with upconverting nanoparticle (UCNP) reporters. Here we report a new methodological approach to quantify cTnI using UCNP-LFIA technology with minimized plasma interference. The performance of the developed UCNP-LFIA was evaluated using clinical plasma samples (n = 262). The developed UCNP-LFIA was compared to two reference assays, the Siemens Advia Centaur assay and an in-house well-based cTnI assay. By introducing an anti-IgM scrub line and dried EDTA in the LFIA strip, the detection of cTnI in plasma samples was fully recovered. The UCNP-LFIA was able to quantify cTnI concentrations in patient samples within the range of 30-10,000 ng/L. The LoB and LoD of the UCNP-LFIA were 8.4 ng/L and 30 ng/L. The method comparisons showed good correlation (Spearman's correlation 0.956 and 0.949, p < 0.0001). The developed UCNP-LFIA had LoD suitable for ruling in AMI in patients with elevated cTnI levels and was able to quantify cTnI concentrations in patient samples. The technology has potential to provide simple and rapid assay for POCT in ED setting.
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Affiliation(s)
- Sherif Bayoumy
- Department of Biotechnology, University of Turku, Turku, Finland.
| | | | - Taina Heikkilä
- Department of Biotechnology, University of Turku, Turku, Finland
| | - Carita Rautanen
- Department of Biotechnology, University of Turku, Turku, Finland
| | - Pirjo Hedberg
- Cancer Research and Translational Medicine Research Unit, Department of Clinical Chemistry, University of Oulu, Kajaanintie 50, 90220, Oulu, Finland
- The Joint Municipal Service Provider of Northern Finland Laboratory Centre (NordLab), Kiviharjuntie 11, 90220, Oulu, Finland
| | - Heidi Hyytiä
- Department of Biotechnology, University of Turku, Turku, Finland
| | - Saara Wittfooth
- Department of Biotechnology, University of Turku, Turku, Finland
| | - Kim Pettersson
- Department of Biotechnology, University of Turku, Turku, Finland
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8
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Juskewitch JE, Zuccarelli MD, Clymer KK, Wakefield LL, Kreuter JD, Gandhi MJ. Prozone rates in the solid-phase platelet crossmatch assay and correlation with class I HLA antibody levels. Transfusion 2021; 61:3236-3246. [PMID: 34523730 DOI: 10.1111/trf.16660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/28/2021] [Accepted: 08/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Solid-phase platelet crossmatch (PXM) testing is used to help manage patients with platelet transfusion-refractoriness. Recently, we published the first report of false-negative PXM results from prozone effect that was mitigated using sample dilution. This study aimed to describe the prevalence of PXM prozone effect and the levels of class I HLA antibodies (HLA-Abs) associated with positive PXM results and with false-negative PXM results from prozone effect. STUDY DESIGN AND METHODS A cross-sectional study of patients undergoing PXM testing from July 2019 through December 2020 was performed. All PXM tests were run simultaneously using undiluted and 1:4 diluted patient plasma. Prozone effect was defined as a negative PXM result using undiluted patient plasma but a positive PXM result using 1:4 diluted patient plasma. RESULTS Among 59 patients, 830 individual ABO-compatible PXM results yielded an overall positivity rate of 25.8% (214/830) and a false-negative rate from prozone effect of 4.7% (10/214). Among the 28 patients with class I HLA-Ab testing and no other anti-platelet antibodies, maximum HLA-Ab mean fluorescence intensity (MFI) was significantly associated with a positive PXM result (p < .0001; AUC approx. 0.9) and categorized into negative (<3700), indeterminate (3700-10300), and positive (>10300) maximum HLA-Ab MFI zones. Maximum HLA-Ab MFI, however, was not associated with prozone effect (p = .17; AUC approx. 0.6). DISCUSSION While there is a strong predictive association between class I HLA-Ab levels and positive PXM results, PXM prozone effect is a common occurrence not associated with class I HLA-Ab levels, so additional testing with diluted samples should be considered.
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Affiliation(s)
- Justin E Juskewitch
- Division of Transfusion Medicine, Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Micah D Zuccarelli
- Division of Transfusion Medicine, Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristie K Clymer
- Division of Transfusion Medicine, Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Laurie L Wakefield
- Division of Transfusion Medicine, Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Justin D Kreuter
- Division of Transfusion Medicine, Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Manish J Gandhi
- Division of Transfusion Medicine, Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
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9
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Rosser C, Sage D. Approaches for the characterization of clinically relevant pre-transplant human leucocyte antigen (HLA) antibodies in solid organ transplant patients. Int J Immunogenet 2021; 48:385-402. [PMID: 34346180 DOI: 10.1111/iji.12552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/30/2021] [Accepted: 07/22/2021] [Indexed: 11/27/2022]
Abstract
The avoidance of antibody-mediated rejection (AMR) attributed to human leucocyte antigen (HLA) antibody incompatibility remains an essential function of clinical Histocompatibility and Immunogenetics (H&I) laboratories who are supporting solid organ transplantation. Developments in HLA antibody identification assays over the past thirty years have greatly reduced unexpected positive cellular crossmatches and improved solid organ transplant outcomes. For sensitized patients, the decision to register unacceptable HLA antigen mismatches is often heavily influenced by results from solid phase antibody assays, particularly the Luminex® Single Antigen Bead (SAB) assays, although the clinical relevance of antibodies identified solely by these assays remains unclear. As such, the identification of non-clinically relevant antibodies may proportionally increase the number of unacceptable transplant mismatches registered, with an associated increase in waiting time for a compatible organ. We reflect on the clinical relevance of antibodies identified solely by the Luminex SAB® assays and consider whether the application of additional assays and/or tools could further develop our ability to define the clinical relevance of antibodies identified in patient sera. Improvements in this area would assist equity of access to a compatible transplant for highly sensitized patients awaiting a solid organ transplant.
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Affiliation(s)
- Carla Rosser
- NHS Blood and Transplant (Tooting), Histocompatibility and Immunogenetics, London, UK
| | - Deborah Sage
- NHS Blood and Transplant (Tooting), Histocompatibility and Immunogenetics, London, UK
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10
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Defining the structural basis for human leukocyte antigen reactivity in clinical transplantation. Sci Rep 2020; 10:18397. [PMID: 33110123 PMCID: PMC7591533 DOI: 10.1038/s41598-020-75355-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022] Open
Abstract
The current state-of-the-art technology employed to assess anti-human leukocyte antigen antibodies (Anti-HLA Ab) for donor-recipient matching and patient risk stratification in renal transplantation is the single antigen bead (SAB) assay. However, there are limitations to the SAB assay as it is not quantitative and due to variations in techniques and reagents, there is no standardization across laboratories. In this study, a structurally-defined human monoclonal alloantibody was employed to provide a mechanistic explanation for how fundamental alloantibody biology influences the readout from the SAB assay. Performance of the clinical SAB assay was evaluated by altering Anti-HLA Ab concentration, subclass, and detection reagents. Tests were conducted in parallel by two internationally accredited laboratories using standardized protocols and reagents. We show that alloantibody concentration, subclass, laboratory-specific detection devices, subclass-specific detection reagents all contribute to a significant degree of variation in the readout. We report a significant prozone effect affecting HLA alleles that are bound strongly by the test alloantibody as opposed to those bound weakly and this phenomenon is independent of complement. These data highlight the importance for establishing international standards for SAB assay calibration and have significant implications for our understanding of discordance in previous studies that have analyzed its clinical relevance.
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11
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Horton RK, Zuccarelli MD, Wakefield LL, DiGuardo MA, Gandhi MJ, Juskewitch JE. False-negative solid-phase platelet crossmatch results due to prozone phenomenon. Transfusion 2020; 60:3055-3059. [PMID: 33047855 DOI: 10.1111/trf.16132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022]
Abstract
Prozone is a known phenomenon affecting immunoassays causing falsely low or negative results when excess target is present in the test system. For assays used to evaluate immune-mediated platelet (PLT) transfusion refractoriness, prozone-like phenomenon has been described in solid-phase human leukocyte antigen (HLA) antibody testing and can be mitigated by diluting samples or pretreating samples with ethylenediaminetetraacetic acid (EDTA) or dithiothreitol. Prozone phenomenon has not yet been described in solid-phase red blood cell (RBC) adherence PLT crossmatch assays. CASE REPORT: A 40-year-old female with myeloid sarcoma and PLT transfusion refractoriness underwent repeated solid-phase PLT crossmatches; however, crossmatch-compatible PLTs units did not yield adequate PLT count responses. Class I HLA antibody testing with neat, diluted, and EDTA-pretreated serum demonstrated significant prozone-like effect and the presence of numerous high strength HLA antibodies. Based on this HLA antibody profile, HLA antigen-negative PLTs gave an adequate PLT count response. It was noted that the HLA types of her crossmatch-compatible PLTs were incompatible with her HLA antibody profile (eg, HLA-A2). With ABO-identical, HLA-A2-positive PLT units, a solid-phase PLT crossmatch was repeated using undiluted and diluted EDTA plasma. Undiluted EDTA plasma demonstrated negative or weakly positive PLT crossmatches while the diluted EDTA plasma demonstrated strongly positive PLT crossmatches. CONCLUSION: The prozone phenomenon can cause false-negative results in solid-phase RBC adherence PLT crossmatch assays, which can be mitigated with sample dilution. In immune-mediated PLT transfusion-refractory patients with high-strength HLA antibodies, sample dilution should be considered to correctly identify compatible PLT inventory.
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Affiliation(s)
- Rachel K Horton
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Manish J Gandhi
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota
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Juskewitch JE, Zuccarelli MD, Berg HE, Summerfield DD, Wakefield LL, Gandhi MJ. Transfusion medicine illustrated: When less is more for HLA antibodies. Transfusion 2020; 61:9-11. [PMID: 32839972 DOI: 10.1111/trf.16037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Micah D Zuccarelli
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Holly E Berg
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Laurie L Wakefield
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Manish J Gandhi
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA
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13
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Juskewitch JE, Gandhi MJ, Kreuter JD, Norgan AP. Development and performance characteristics of Platelet Virtual Crossmatch (PLT VXM), a software application for the evaluation and management of platelet transfusion-refractory patients. Transfusion 2020; 60:2284-2293. [PMID: 32827167 DOI: 10.1111/trf.16025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Platelet (PLT) transfusion refractoriness increases bleeding complications, hospital stays, and PLT inventory usage. Immune-mediated refractoriness can be evaluated for using a physical PLT crossmatch with ABO-compatible inventory and, if positive, managed with HLA-compatible PLT inventory and donors. Manual completion of these complex tasks can be time-consuming and potentially error-prone. This study was conducted to determine if a Web-based software application could improve process efficiency and accuracy. STUDY DESIGN AND METHODS Workflow analysis was performed to identify process, data, and analytic requirements for a software application for three PLT transfusion-refractoriness associated tasks: (a) physical PLT crossmatch inventory selection, (b) HLA-compatible inventory selection, and (c) HLA-compatible donor selection. After software application development, a comparison study was performed over 10 consecutive days, with each task performed manually and with the software application (Platelet Virtual Crossmatch [PLT VXM]) for a different unique immune-mediated PLT transfusion-refractory recipient. Task completion time, number of incompatible units/donors presented, and number of documentation errors were compared. RESULTS PLT VXM is a Web-based software application developed using R and the Shiny Web application framework. PLT VXM significantly reduced median task completion times by 4.5 (49%), 11.2 (79%), and 59.1 minutes (94%), respectively. PLT VXM did not present any incompatible PLT units or donors for user consideration. PLT VXM also had a lower number of documentation errors than the manual process, and none of these documentation errors were software generated. CONCLUSION Computer-aided evaluation and management of immune-mediated PLT transfusion-refractory recipients can significantly improve workflow and reduce manual errors in this complex process.
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Affiliation(s)
- Justin E Juskewitch
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Manish J Gandhi
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Justin D Kreuter
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew P Norgan
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Buttigieg J, Ali H, Sharma A, Halawa A. Positive Luminex and negative flow cytometry in kidney transplantation: a systematic review and meta-analysis. Nephrol Dial Transplant 2018; 34:1950-1960. [DOI: 10.1093/ndt/gfy349] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/10/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
The presence of pre-formed donor-specific antibodies (DSAs) in kidney transplantation is associated with worse overall outcomes compared with DSA-negative transplantation. A positive complement-dependant cytotoxic crossmatch presents a high immunological risk, while a negative flow cytometry crossmatch is at the lower end of the risk spectrum. Yet, the presence of low-level DSA detected by Luminex alone, that is, positive Luminex and negative flow (PLNF) cytometry crossmatch lacks robust scientific exploration. In this systematic review and pooled analysis, we investigate the glomerular filtration rate, acute rejection (AR), graft survival and patient survival of PLNF transplants compared with DSA-negative transplants. Our analysis identified seven retrospective studies consisting of 429 PLNF transplants and 10 677 DSA-negative transplants. Pooled analysis identified no significant difference in the incidence of AR at 1 year [relative risk (RR) = 1.35, 95% confidence interval (CI) 0.90–2.02, Z = 1.46, P = 0.14, I2 = 0%], graft failure at 1 year (RR = 1.66, 95% CI 0.94–2.94, Z = 1.75, P = 0.08, I2 = 23%), graft failure at 5 years (RR = 1.29, 95% CI 0.90–1.87, Z = 1.38, P = 0.17, I2 = 0%), patient mortality at 1 year (RR = 0.89, 95% CI 0.31–2.56, Z = 0.22, P = 0.82, I2 = 0%) and patient mortality at 5 years (RR = 1.76, 95% CI 0.48–6.48, Z = 0.85, P = 0.39, I2 = 61%). Pooled analysis of graft function was not possible due to insufficient data. Current evidence suggests that low-level DSA detected by Luminex alone does not pose significant risk at least in the short–medium term. Considering the shortage of kidney transplants and the ever-increasing waiting time, the avoidance of PLNF transplants may be unwarranted especially in patients who have been enlisted for a long time.
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Affiliation(s)
- Jesmar Buttigieg
- Renal Division, Department of Medicine, Mater Dei Hospital, Malta
- Faculty of Health and Life Science, Institute of Learning and Teaching, University of Liverpool, Liverpool, UK
| | - Hatem Ali
- Faculty of Health and Life Science, Institute of Learning and Teaching, University of Liverpool, Liverpool, UK
- Department of Renal Medicine, Royal Wolverhampton Hospitals NHS Foundation Trust, Wolverhampton, UK
| | - Ajay Sharma
- Faculty of Health and Life Science, Institute of Learning and Teaching, University of Liverpool, Liverpool, UK
- Renal Transplant Unit, Royal Liverpool University Hospital, NHS Trust, Liverpool, UK
| | - Ahmed Halawa
- Faculty of Health and Life Science, Institute of Learning and Teaching, University of Liverpool, Liverpool, UK
- Renal Transplant Unit, Sheffield Teaching Hospitals, NHS Trust, Sheffield, UK
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15
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Morrison BJ, Martin NJ, Rehman T, Ewing D, Dewar RL, Metcalf J, Sun P, Beigel J, Luke TC, Raviprakash K. Influence of sample collection tube method, anticoagulant-containing plasma versus serum, on influenza virus hemagglutination inhibition titer and microneutralization titer serological assays. BMC Health Serv Res 2018; 18:651. [PMID: 30134892 PMCID: PMC6103864 DOI: 10.1186/s12913-018-3465-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/13/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The hemagglutination-inhibition (HAI) assay is a critical component for measurement of immunogenicity in influenza vaccine development. It is unknown if the results can be influenced by sample type and anticoagulants. The purpose of this study was to evaluate the influence of different sample collection methods, in particular different anticoagulants, and choice of plasma or serum, on influenza virus serological assays. METHODS Blood samples from thirty donors previously immunized against influenza viruses were collected using six different types of blood collection tubes, two of which collect serum and four of which contain various anticoagulants for collecting plasma. Serum: (1) serum separator tubes (SST); and (2) Plus Plastic serum "red-top serum" tubes. Plasma: (3) spray-coated K2 ethylenediaminetetraacetic acid (EDTA) tubes: (4) Sodium Heparin tubes; (5) Citrate tubes with 3.2% sodium citrate solution; and (6) Glass Blood Collection tubes with acid citrate dextrose. Samples were tested against three different influenza viruses (A/California/07/2009 (H1N1pdm09), A/Texas/50/2012 (H3N2), and B/Massachusetts/2/2012) for hemagglutination inhibition titer and virus neutralization titer via a microneutralization (MN) assay, and data compared to that obtained for standard serum sample collected in SST. RESULTS HAI and MN titers against type A viruses were within two dilutions compared to SST collection method over 96% of the time irrespective of sample type or anticoagulant. However, HAI titers for type B virus were more variable across different collection methods. EDTA plasma samples were greater than two dilutions higher than SST serum samples 70% (21 of 30 samples) of the time. In contrast, MN titers were within two dilutions over 96% of the time, with the highest deviation noted in acid citrate dextrose plasma samples (3 of 30 samples tested, 10%). CONCLUSIONS These data provide useful guidelines for sample collection and serology testing when screening: (i) influenza vaccine immunogenicity antibody response; (ii) antibody responses to newly emerging viral strains; and (iii) clinical samples for anti-influenza antibody activity.
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Affiliation(s)
- Brian J. Morrison
- Viral and Rickettsial Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA
| | | | | | - Dan Ewing
- Viral and Rickettsial Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA
| | | | - Julia Metcalf
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20817 USA
| | - Peifang Sun
- Viral and Rickettsial Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA
| | - John Beigel
- Leidos Biomedical Research, Frederick, MD 21702 USA
| | - Thomas C. Luke
- Viral and Rickettsial Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA
| | - Kanakatte Raviprakash
- Viral and Rickettsial Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA
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16
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Guidicelli G, Visentin J, Franchini N, Borg C, Merville P, Couzi L, Taupin JL. Prevalence, distribution and amplitude of the complement interference phenomenon in single antigen flow beads assays. HLA 2018; 91:507-513. [DOI: 10.1111/tan.13263] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- G. Guidicelli
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique; Hôpital Pellegrin; Bordeaux France
| | - J. Visentin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique; Hôpital Pellegrin; Bordeaux France
- Université de Bordeaux; Bordeaux France
- Immuno ConcEpT, UMR CNRS 5164; Bordeaux France
| | - N. Franchini
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique; Hôpital Pellegrin; Bordeaux France
| | - C. Borg
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique; Hôpital Pellegrin; Bordeaux France
| | - P. Merville
- Université de Bordeaux; Bordeaux France
- Immuno ConcEpT, UMR CNRS 5164; Bordeaux France
- CHU de Bordeaux, Service de Néphrologie, Transplantation, Dialyse et Aphérèses; Bordeaux France
| | - L. Couzi
- Université de Bordeaux; Bordeaux France
- Immuno ConcEpT, UMR CNRS 5164; Bordeaux France
- CHU de Bordeaux, Service de Néphrologie, Transplantation, Dialyse et Aphérèses; Bordeaux France
| | - J.-L. Taupin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique; Hôpital Pellegrin; Bordeaux France
- Université de Bordeaux; Bordeaux France
- Immuno ConcEpT, UMR CNRS 5164; Bordeaux France
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17
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The European Society for Blood and Marrow Transplantation (EBMT) Consensus Guidelines for the Detection and Treatment of Donor-specific Anti-HLA Antibodies (DSA) in Haploidentical Hematopoietic Cell Transplantation. Bone Marrow Transplant 2018; 53:521-534. [PMID: 29335625 DOI: 10.1038/s41409-017-0062-8] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/11/2017] [Accepted: 11/17/2017] [Indexed: 01/05/2023]
Abstract
Haploidentical donors are now increasingly considered for transplantation in the absence of HLA-matched donors or when an urgent transplant is needed. Donor-specific anti-HLA antibodies (DSA) have been recently recognized as an important barrier against successful engraftment of donor cells, which can affect transplant survival. DSA appear more prevalent in this type of transplant due to higher likelihood of alloimmunization of multiparous females against offspring's HLA antigens, and the degree of mismatch. Here we summarize the evidence for the role of DSA in the development of primary graft failure in haploidentical transplantation and provide consensus recommendations from the European Society for Blood and Marrow Transplant Group on testing, monitoring, and treatment of patients with DSA receiving haploidentical hematopoietic progenitor cell transplantation.
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18
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Antibody-mediated rejection in heart transplantation: new developments and old uncertainties. Curr Opin Organ Transplant 2017; 22:207-214. [PMID: 28301387 DOI: 10.1097/mot.0000000000000407] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Antibody-mediated rejection (AMR) currently represents one of the main problems for clinical management of heart transplant because of its diagnostic complexity and poor evidences supporting treatments. RECENT FINDINGS Disorder-based diagnosis is a cornerstone in defining AMR. The limitations of the current classification have been partially overcome by novel studies improving the description of the immune-pathological graft abnormalities, and by new molecular approaches allowing a better understanding of the mechanisms behind AMR and of its relationship with cellular rejection and chronic vasculopathy. In-depth characterization of donor-specific antibodies showed to provide additional prognostic information and guide for treatment. Clinical relevance of AMR is bound to appropriate detection of graft dysfunction. In addition to traditional longitudinal evaluation by echocardiogram, cardiac magnetic resonance and detection of cell-free DNA may represent novel sensitive markers for graft injury that could prompt treatment before dysfunction becomes clinically manifest. SUMMARY Despite improvements in the diagnostic process, therapeutic strategies made little progress in addition to the consolidation of practices supported by limited evidences. Novel complement inhibitors appear promising in changing this scenario. Nevertheless, collaborative multicenter studies are needed to develop standardized approaches tailored to the highly variable clinical and laboratory features of AMR.
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19
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Clerkin KJ, See SB, Farr MA, Restaino SW, Serban G, Latif F, Li L, Colombo PC, Vlad G, Ray B, Vasilescu ER, Zorn E. Comparative Assessment of Anti-HLA Antibodies Using Two Commercially Available Luminex-Based Assays. Transplant Direct 2017; 3:e218. [PMID: 29184907 PMCID: PMC5682763 DOI: 10.1097/txd.0000000000000734] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/09/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Allospecific anti-HLA antibodies (Abs) are associated with rejection of solid organ grafts. The 2 main kits to detect anti-HLA Ab in patient serum are commercialized by Immucor and One Lambda/ThermoFisher. We sought to compare the performance of both platforms. METHODS Background-adjusted mean fluorescence intensity (MFI) values were used from both platforms to compare sera collected from 125 pretransplant and posttransplant heart and lung transplant recipients. RESULTS Most HLA class I (94.5%) and HLA class II (89%) Abs with moderate to high MFI titer (≥4000) were detected by both assays. A modest correlation was observed between MFI values obtained from the 2 assays for both class I (r = 0.3, r2 = 0.09, P < 0.0001) and class II Ab (r = 0.707, r2 = 0.5, P < 0.0001). Both assays detected anti-class I and II Ab that the other did not; however, no specific HLA allele was detected preferentially by either of the 2 assays. For a limited number of discrepant sera, dilution resulted in comparable reactivity profiles between the 2 platforms. CONCLUSIONS Immucor and One Lambda/ThermoFisher assays have a similar, albeit nonidentical, ability to detect anti-HLA Ab. Although the correlation between the assays was present, significant variances exist, some of which can be explained by a dilution-sensitive "prozone" effect.
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Affiliation(s)
- Kevin J. Clerkin
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Sarah B. See
- Columbia Center for Translational Immunology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Maryjane A. Farr
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Susan W. Restaino
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Geo Serban
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Farhana Latif
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Lingzhi Li
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Paolo C. Colombo
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - George Vlad
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY
| | | | - Elena R. Vasilescu
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Emmanuel Zorn
- Columbia Center for Translational Immunology, Columbia University College of Physicians and Surgeons, New York, NY
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20
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Juskewitch JE, Norgan AP, De Goey SR, Duellman PM, Wakefield LL, Gandhi MJ, Stubbs JR, Kreuter JD. How do I … manage the platelet transfusion-refractory patient? Transfusion 2017; 57:2828-2835. [PMID: 28960321 DOI: 10.1111/trf.14316] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 06/27/2017] [Accepted: 07/29/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Platelet transfusion-refractoriness is a challenging and expensive clinical scenario seen most often in patients with hematologic malignancies. Although the majority of platelet transfusion-refractory cases are due to nonimmune causes, a significant minority are caused by alloimmunization against Class I human leukocyte antigens (HLAs) or human platelet antigens (HPAs). Such platelet transfusion-refractory patients can be effectively managed with appropriate antigen-negative products. STUDY DESIGN AND METHODS Our institution has developed a diagnostic and management algorithm for the platelet transfusion-refractory patient with an early focus on identifying those cases caused by immune-mediated factors. Using physical platelet cross-matches to initially classify platelet transfusion-refractory patients as immune-mediated or not, cross-match-compatible inventory is then provided to immune-mediated patients, whereas subsequent HLA (with or without HPA) testing is performed. RESULTS Our blood donor program performs Class I HLA typing of all repeat platelet donors to facilitate the identification of antigen-negative platelet units (virtual cross-matching) as well as the recruitment of HLA-matched donors. The platelet transfusion-refractoriness algorithm realizes an initial net cost savings once two apheresis platelets are saved from use for each newly identified, immune-mediated platelet transfusion-refractory patient. CONCLUSION An algorithm utilizing physical platelet cross-matches, Class I HLA and HPA antibody testing, and upfront Class I HLA typing of platelet donors leads to overall resource savings and improved clinical management for platelet transfusion-refractory patients.
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Affiliation(s)
- Justin E Juskewitch
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Andrew P Norgan
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Steven R De Goey
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Patti M Duellman
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Laurie L Wakefield
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Manish J Gandhi
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - James R Stubbs
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Justin D Kreuter
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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21
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Zhang X, Reinsmoen NL. Comprehensive assessment for serum treatment for single antigen test for detection of HLA antibodies. Hum Immunol 2017; 78:699-703. [PMID: 28899793 DOI: 10.1016/j.humimm.2017.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
The single antigen test is widely used in the field of transplantation to determine the specificity of HLA antibodies. It will be beneficial to standardize the procedure of the single antigen test among HLA laboratories. It is not uncommon that single antigen testing on native sera fails to detect antibodies with very high concentrations. It has been shown that cleavage products of activated complement components may mask strongly binding antibodies in single antigen testing. To overcome inhibition by the activated complement products, sera are pretreated with ethylenediaminetetraacetic acid (EDTA), dithiothreitol (DTT), or heat inactivation before single antigen testing. However, no studies have been published to systemically compare the impact of these treatments on single antigen testing. The aim of this study is to understand the different effects these treatments may have on single antigen test results. We found that mean fluorescence intensity (MFI) obtained from sera treated with EDTA and heat inactivation were nearly identical, while DTT treatment was less potent to remove the inhibition. In addition, sera dilution did not further increase MFI of antibodies after EDTA treatment. Our results provide guidance to choose a pretreatment reagent for single antigen testing, and to compare studies obtained from laboratories using different treatments.
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Affiliation(s)
- Xiaohai Zhang
- HLA and Immunogenetics Laboratory, Comprehensive Transplant Center, Cedars-Sinai Health System, 8723 Alden Drive, SSB 197, Los Angeles, CA 90048, United States.
| | - Nancy L Reinsmoen
- HLA and Immunogenetics Laboratory, Comprehensive Transplant Center, Cedars-Sinai Health System, 8723 Alden Drive, SSB 197, Los Angeles, CA 90048, United States
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22
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Quantitative Evaluation of the Impact of Ethylenediaminetetraacetic Acid Pretreatment on Single-Antigen Bead Assay. Transplant Direct 2017; 3:e194. [PMID: 28795145 PMCID: PMC5540632 DOI: 10.1097/txd.0000000000000709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/23/2017] [Indexed: 01/28/2023] Open
Abstract
Background Ethylenediaminetetraacetic acid (EDTA) pretreatment has been shown to overcome complement interference in the single-antigen bead (SAB) assay. However, a quantitative evaluation of its impact on the assay for preemptive application to diverse clinical samples is still lacking. Methods Serum samples from 95 renal transplant candidates were tested with and without EDTA-pretreatment in parallel. Changes in mean fluorescence intensity (MFI) values were analyzed to determine the impact of EDTA-pretreatment and the characteristics of complement interference. Results MFI values from EDTA-treated and untreated sera showed good correlations (r = 0.99) and were linear after excluding outliers (slopes, 1; intercepts, −63.7 and −24.2 for class I and II, respectively). Using an assay cutoff of 2000 MFI, positive/negative assignments were concordant for 99% of the 9215 class I beads and 9025 class II beads tested. As defined by an MFI increment above 4000 after EDTA pretreatment, complement interference affected 172 class I beads in 12 samples (12.6%) and 60 class II beads in 7 samples (7.4%), and the findings were supported in 83% and 86% of these samples by dilution studies. In a case study, EDTA pretreatment prevented falsely low MFI values and facilitated the interpretation of titration curves. Finally, EDTA pretreatment reduced the coefficient of variance (CV) by 2.1% and 2.4% for class I and II beads respectively (P < 0.0001). Conclusions It is safe to preemptively treat all clinical samples with EDTA before SAB assay to prevent false negative results or falsely low MFI values. EDTA pretreatment has the added benefit of improved assay precision.
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24
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Wang J, Meade JR, Brown NK, Weidner JG, Marino SR. EDTA is superior to DTT treatment for overcoming the prozone effect in HLA antibody testing. HLA 2017; 89:82-89. [DOI: 10.1111/tan.12950] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- J. Wang
- Department of Pathology; University of Chicago Medicine; Chicago Illinois
| | - J. R. Meade
- Department of Pathology; University of Chicago Medicine; Chicago Illinois
| | - N. K. Brown
- Department of Pathology; University of Chicago Medicine; Chicago Illinois
| | - J. G. Weidner
- Department of Pathology; University of Chicago Medicine; Chicago Illinois
| | - S. R. Marino
- Department of Pathology; University of Chicago Medicine; Chicago Illinois
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