1
|
de Marco R, Requião-Moura LR, Raimundo TRF, Mourão TB, Rampim GF, Medina-Pestana JO, Tedesco-Silva H, Gerbase-DeLima M. HLA-DPB1 molecular mismatches are risk factors for acute rejection and low 5-year graft function in first kidney transplants. HLA 2023; 101:228-238. [PMID: 36461794 DOI: 10.1111/tan.14911] [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: 09/07/2022] [Revised: 11/14/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022]
Abstract
The study aimed to investigate the impact of HLA-DPB1 allelic and molecular mismatches on the occurrence of acute rejection (AR) and low 5-year graft function (5Y-GF) in first kidney transplant (KT) recipients. This is a single center retrospective study of 130 deceased donor KT recipients transplanted between 2014 and 2016. HLA-DPB1 allelic MM and the following molecular MM (mMM) were analyzed: expression MM with the high expression G allele in the donor; T cell epitope MM (TCE MM); epitope MM (EMM), considering all six hypervariable regions (EMM-ABCDEF HVR), or only ABEF regions (EMM-ABEF HVR); eplet MM (EpMM); antibody-verified eplet MM (AbVer EpMM); and solvent accessible amino acid MM (SAMM). There was no association of allelic MM with AR or 5Y-GF. The variables independently associated (Cox regression analyses) with AR were high donor final creatinine, nonpermissive TCE MM, ABCDEF EMM load ≥6, EpMM load ≥6; SAMM load ≥5, and AbVer EpMM load ≥3. No association between any HLA-DPB1 mMM and 5Y-GF was observed when all 130 transplant recipients were considered. However, when transplants from expanded criteria donors were excluded, independent associations were detected (logistic regression analyses) with AbVerEpMM load ≥2, SAMM load ≥7, cerebro-vascular death, donor age, and AR. To our knowledge, this is the first study that shows that some HLA-DPB1 mMM are associated with AR and low 5Y-GF in a population of exclusively first kidney transplant recipients.
Collapse
Affiliation(s)
- Renato de Marco
- Instituto de Imunogenética (IGEN), Associação Fundo de Incentivo à Pesquisa (AFIP), São Paulo, Brazil
| | - Lúcio R Requião-Moura
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tamiris R F Raimundo
- Instituto de Imunogenética (IGEN), Associação Fundo de Incentivo à Pesquisa (AFIP), São Paulo, Brazil
| | - Tuíla B Mourão
- Instituto de Imunogenética (IGEN), Associação Fundo de Incentivo à Pesquisa (AFIP), São Paulo, Brazil
| | - Gisele F Rampim
- Instituto de Imunogenética (IGEN), Associação Fundo de Incentivo à Pesquisa (AFIP), São Paulo, Brazil
| | - José O Medina-Pestana
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Hélio Tedesco-Silva
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria Gerbase-DeLima
- Instituto de Imunogenética (IGEN), Associação Fundo de Incentivo à Pesquisa (AFIP), São Paulo, Brazil
| |
Collapse
|
2
|
Seitz A, Mounsey K, Hughes P, Cullen K, Welberry Smith M, Daga S, Carter C, Clark B, Baker R. Isolated Pre-existing HLA-DP Donor-Specific Antibodies are Associated With Poorer Outcomes in Renal Transplantation. Kidney Int Rep 2022; 7:2251-2263. [PMID: 36217531 PMCID: PMC9546735 DOI: 10.1016/j.ekir.2022.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction The importance of donor-specific antibodies (DSAs) in renal transplantation has long been recognized, but the significance of human leukocyte antigen (HLA)-DP antibodies remains less clear. We performed a retrospective single center study of renal transplants with pre-existing isolated HLA-DP-DSAs to assess clinical outcomes. Methods Twenty-three patients with isolated HLA-DP-DSAs were compared with 3 control groups as follows: standard immunological risk (calculated reaction frequency [cRF] < 85%, no current or historical DSA, no repeat mismatched antigens with previous transplants, n = 46), highly sensitized (cRF > 85%, n = 27), and patients with HLA-DP antibodies that were not donor-specific (n = 18). Univariate and multivariate analyses were performed comparing antibody-mediated rejection (ABMR)-free and graft survival. Factors in the final multivariable models included patient group, % cRF, B-cell flow crossmatch (BFXM) positivity and regrafts. Results Over a median follow-up of 1197 days, 65% of HLA-DP-DSA patients had ABMR on indication biopsies, and 30% of HLA-DP-DSA patients lost their graft. Pre-existing HLA-DP DSAs remained the single factor associated with ABMR after multivariable analysis (hazard ratio [HR] = 9.578, P = 0.012). Patients with HLA-DP DSAs had increased microvascular scores (P = 0.0346) and worse transplant glomerulopathy (P = 0.015) on biopsy compared with the standard immunological risk group. Furthermore, flow crossmatch (FXM) positivity did not help inform on the risk of graft failure or ABMR in patients with preformed DP-DSA. Conclusion Transplants with pre-existing HLA-DP-DSAs should be considered high risk. Routine laboratory tests are unable to further risk stratify these patients. Recipients should be considered for intensified immunosuppression and closely monitored.
Collapse
Affiliation(s)
- Adrienne Seitz
- Renal Transplant Unit, St James’s University Hospital, Leeds, UK
- Transplant Immunology, St James’s University Hospital, Leeds, UK
- Correspondence: Adrienne Seitz, Renal Transplant Unit, St James's University Hospital, Leeds, UK.
| | | | - Pamela Hughes
- Transplant Immunology, St James’s University Hospital, Leeds, UK
| | - Katherine Cullen
- Transplant Immunology, St James’s University Hospital, Leeds, UK
| | | | - Sunil Daga
- Renal Transplant Unit, St James’s University Hospital, Leeds, UK
| | - Clive Carter
- Transplant Immunology, St James’s University Hospital, Leeds, UK
| | - Brendan Clark
- Transplant Immunology, St James’s University Hospital, Leeds, UK
| | - Richard Baker
- Renal Transplant Unit, St James’s University Hospital, Leeds, UK
| |
Collapse
|
3
|
Tang C, Unterrainer C, Fink A, Cinca S, Ruhenstroth A, Scherer S, Morath C, Zeier M, Mehrabi A, Süsal C, Tran TH. Analysis of de novo donor-specific HLA-DPB1 antibodies in kidney transplantation. HLA 2021; 98:423-430. [PMID: 34480415 DOI: 10.1111/tan.14422] [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: 04/28/2021] [Revised: 08/17/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022]
Abstract
HLA matching and avoidance of unacceptable mismatches are important aspects in the selection of donors for solid organ transplantation. The impact of HLA-DPB1 incompatibility on the outcomes of kidney transplantation is not fully understood. We investigated a potential effect of mismatching for HLA-DPB1 at allele, eplet, or Terasaki epitope (TerEp) level on the formation of de novo donor-specific antibodies (dnDSA) and also asked whether polymorphisms associated with HLA-DPB1 expression level may influence dnDSA induction. Furthermore, we analyzed the correlation between graft survival and HLA-DPB1 mismatches defined by different approaches. A cohort of 366 patients who received a kidney transplant at the Heidelberg University Hospital, Germany, with availability of pre- and post-transplant HLA antibody results by single antigen testing as well as of donor and recipient HLA-DPB1 high-resolution typing were analyzed retrospectively. Susceptibility to increased HLA-DPB1 expression was predicted by the linked dimorphism rs9277534 A/G of the HLA-DPB1 gene. Neither HLA-DPB1 mismatches at allele, eplet or TerEp level nor exposure to donor's high HLA-DPB1 expression were significantly associated with the risk of developing dnDSA against HLA-DPB1. However, HLA-DPB1 eplet and TerEp mismatches had a significant negative impact on graft survival (p < 0.001 and p = 0.003, respectively). Matching for HLA-DPB1 at epitope instead of allele level appears to have potential to improve graft survival in kidney transplantation.
Collapse
Affiliation(s)
- Chen Tang
- Transplantation Immunology, Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Unterrainer
- Transplantation Immunology, Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Annette Fink
- Transplantation Immunology, Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sofia Cinca
- Transplantation Immunology, Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andrea Ruhenstroth
- Transplantation Immunology, Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Scherer
- Transplantation Immunology, Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Morath
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Zeier
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Caner Süsal
- Transplantation Immunology, Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thuong Hien Tran
- Transplantation Immunology, Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
4
|
Renal transplantation against a positive crossmatch due to HLA-DP donor-specific antibodies without prior antibody removal – Case report. TRANSPLANTATION REPORTS 2021. [DOI: 10.1016/j.tpr.2021.100076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
5
|
Teles E Oliveira DM, Marroquim MSC, de Serpa Brandão RMS, da Mata Sousa LCD, das Chagas Alves Lima F, do Monte SJH, de Sousa Lima AV, Coelho AGB, Costa JMS, Ramos RM, Miranda Pereira E, da Silva AS. pHLA3D: Updating the database of predicted three-dimensional structures of HLA with HLA-DR, HLA-DQ and HLA-DP molecules. Hum Immunol 2020; 82:8-10. [PMID: 33129577 DOI: 10.1016/j.humimm.2020.10.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 01/04/2023]
Abstract
To improve the availability of three-dimensional (3D) structures of HLA molecules, we created the pHLA3D database. In its first version, we modeled and published 106 3D structures of HLA class I molecules from the HLA-A, HLA-B, and HLA-C loci. This paper presents an update of this database, providing more 127 3D structures of HLA class II molecules (41 DR, 42 DQ, and 44 DP), predicted via homology modeling with MODELLER and SWISS-MODEL. These new 3D structures of HLA class II molecules are now freely available at pHLA3D (www.phla3d.com.br) for immunologists and other researchers working with HLA molecules.
Collapse
Affiliation(s)
| | | | | | - Luiz Claudio Demes da Mata Sousa
- Laboratory of Immunogenetics and Molecular Biology, Federal University of Piauí, Teresina, PI, Brazil; Department of Computation, Federal University of Piauí, Teresina, PI, Brazil
| | - Francisco das Chagas Alves Lima
- Research Group in Computational Quantum Chemistry & Pharmaceutical Planning, State University of Piauí, Teresina, PI, Brazil; Department of Chemistry, State University of Piauí, Teresina, PI, Brazil
| | | | | | | | | | - Ricardo Martins Ramos
- Research Laboratory in Information Systems, Federal Institute of Piauí, Teresina, PI, Brazil; Department of Information, Environment, Health and Food Production, Federal Institute of Piauí, Teresina, PI, Brazil
| | - Ester Miranda Pereira
- Laboratory of Immunogenetics and Molecular Biology, Federal University of Piauí, Teresina, PI, Brazil
| | - Adalberto Socorro da Silva
- Laboratory of Immunogenetics and Molecular Biology, Federal University of Piauí, Teresina, PI, Brazil; Department of Biology, Federal University of Piauí, Teresina, PI, Brazil.
| |
Collapse
|
6
|
Koga K, Wang B, Kaneko S. Current status and future perspectives of HLA-edited induced pluripotent stem cells. Inflamm Regen 2020; 40:23. [PMID: 33014207 PMCID: PMC7528263 DOI: 10.1186/s41232-020-00132-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022] Open
Abstract
In 2007, Human-induced pluripotent stem cells (iPSCs) were generated by transducing four genes (Oct3/4, Sox2, Klf4, c-Myc). Because iPSCs can differentiate into any types of cells in the body and have fewer ethical issues compared to embryonic stem (ES) cells, application of iPSCs for regenerative medicine has been actively examined. In fact, iPSCs have already been used for clinical applications, but at present, only autologous iPSC-derived grafts or HLA homozygous iPSC-derived grafts are being transplanted into patients following HLA matching. HLA is an important molecule that enables the immune system differentiates between self and non-self-components; thus, HLA mismatch is a major hurdle in the transplantation of iPSCs. To deliver inexpensive off-the-shelf iPSC-derived regenerative medicine products to more patients, it is necessary to generate universal iPSCs that can be transplanted regardless of the HLA haplotypes. The current strategy to generate universal iPSCs has two broad aims: deleting HLA expression and avoiding attacks from NK cells, which are caused by HLA deletion. Deletion of B2M and CIITA genes using the CRISPR/Cas9 system has been reported to suppress the expression of HLA class I and class II, respectively. Transduction of NK inhibitory ligands, such as HLA-E and CD47, has been used to avoid NK cell attacks. Most recently, the HLA-C retaining method has been used to generate semi-universal iPSCs. Twelve haplotypes of HLA-C retaining iPSCs can cover 95% of the global population. In future, studying which types of universal iPSCs are most effective for engraftment in various physiological conditions is necessary.
Collapse
Affiliation(s)
- Keiko Koga
- Takeda-CiRA Joint Program (T-CiRA), 2-26-1, Muraoka-Higashi, Fujisawa, Kanagawa 251-8555 Japan.,T-CiRA discovery, Takeda Pharmaceutical Company, 2-26-1, Muraoka-Higashi, Fujisawa, Kanagawa 251-8555 Japan
| | - Bo Wang
- Takeda-CiRA Joint Program (T-CiRA), 2-26-1, Muraoka-Higashi, Fujisawa, Kanagawa 251-8555 Japan.,Shin Kaneko Laboratory, Department of Cell Growth and Differentiation, Center for iPS cell research (CiRA), Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Shin Kaneko
- Takeda-CiRA Joint Program (T-CiRA), 2-26-1, Muraoka-Higashi, Fujisawa, Kanagawa 251-8555 Japan.,Shin Kaneko Laboratory, Department of Cell Growth and Differentiation, Center for iPS cell research (CiRA), Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| |
Collapse
|
7
|
Fukuoka K, Tokodai K, Miyagi S, Nakanishi W, Nishimura R, Fujio A, Watanabe H, Taniuchi S, Naitoh T, Ishida T, Unno M, Kamei T. Chronic Active Antibody-Mediated Rejection With Donor-Specific Anti-HLA-DP Antibodies Following Living Donor Kidney Transplantation: A Case Report. Transplant Proc 2020; 52:1937-1939. [PMID: 32586663 DOI: 10.1016/j.transproceed.2020.02.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/11/2020] [Accepted: 02/22/2020] [Indexed: 11/25/2022]
Abstract
Posttransplant donor-specific anti-HLA antibodies (DSA) cause chronic antibody-mediated rejection. Anti-DR and anti-DQ DSAs have especially been shown to be associated with negative graft function. In contrast, the prevalence and significance of anti-DP DSA have not been well established and remain unclear. We report a case of living donor kidney transplantation. The level of serum creatinine gradually became elevated because of chronic active antibody-mediated rejection, which was considered to be caused by anti-DP DSA. In this report, we indicate the significance of pretransplant screening for HLA-DP in donors to evaluate more comprehensively the donor specificity of posttransplant HLA antibodies.
Collapse
Affiliation(s)
- Kengo Fukuoka
- Department of Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Kazuaki Tokodai
- Department of Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shigehito Miyagi
- Department of Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Wataru Nakanishi
- Department of Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Ryuichi Nishimura
- Department of Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Atsushi Fujio
- Department of Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hirofumi Watanabe
- Department of Pathology, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shinji Taniuchi
- Department of Pathology, Osaki Citizen Hospital, Osaki, Miyagi, Japan
| | - Takeshi Naitoh
- Department of Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Takanori Ishida
- Department of Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| |
Collapse
|
8
|
Farouk S, Zhang Z, Menon MC. Non-HLA donor-recipient mismatches in kidney transplantation-A stone left unturned. Am J Transplant 2020; 20:19-24. [PMID: 31550409 PMCID: PMC7898079 DOI: 10.1111/ajt.15612] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/28/2019] [Accepted: 09/17/2019] [Indexed: 01/25/2023]
Abstract
In kidney transplantation, short-term allograft survival has improved due to improvements in acute rejection episodes without corresponding improvements in long-term survival. Although current organ allocation algorithms take into account human leukocyte antigen (HLA) matching to reduce antidonor alloimmune responses, it is likely that genomic variation at non-HLA loci (ie, non-HLA donor-recipient [D-R] pair mismatches) play a role in the "non-self" responses and ultimately affect long-term allograft survival. Existing data from both animal models and human studies suggest an association between non-HLA D-R mismatches and kidney allograft outcomes. In this minireview, we examine existing and emerging data and discuss putative mechanisms on the role of non-HLA D-R mismatches on long-term allograft outcomes in kidney transplantation.
Collapse
Affiliation(s)
- Samira Farouk
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY,Recanati-Miller transplant institute, Icahn School of Medicine at Mount Sinai, NY
| | - Zhongyang Zhang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY,Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, NY
| | - Madhav C Menon
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY,Recanati-Miller transplant institute, Icahn School of Medicine at Mount Sinai, NY
| |
Collapse
|
9
|
Abstract
The human major histocompatibility complex is a family of genes that encodes HLAs, which have a crucial role in defence against foreign pathogens and immune surveillance of tumours. In the context of transplantation, HLA molecules are polymorphic antigens that comprise an immunodominant alloreactive trigger for the immune response, resulting in rejection. Remarkable advances in knowledge and technology in the field of immunogenetics have considerably enhanced the safety of transplantation. However, access to transplantation among individuals who have become sensitized as a result of previous exposure to alloantigens is reduced proportional to the breadth of their sensitization. New approaches for crossing the HLA barrier in transplantation using plasmapheresis, intravenous immunoglobulin and kidney paired donation have been made possible by the relative ease with which even low levels of anti-HLA antibodies can now be detected and tracked. The development of novel protocols for the induction of tolerance and new approaches to immunomodulation was also facilitated by advances in HLA technology. Here, we review the progress made in understanding HLAs that has enabled organ transplantation to become a life-saving endeavour that is accessible even for sensitized patients. We also discuss novel approaches to desensitization, immunomodulation and tolerance induction that have the potential to further improve transplantation access and outcomes.
Collapse
|
10
|
Resolving MiSeq-Generated Ambiguities in HLA-DPB1 Typing by Using the Oxford Nanopore Technology. J Mol Diagn 2019; 21:852-861. [PMID: 31173929 DOI: 10.1016/j.jmoldx.2019.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/19/2019] [Accepted: 04/30/2019] [Indexed: 12/30/2022] Open
Abstract
The technical limitations of current next-generation sequencing technologies, combined with an ever-increasing number of human leukocyte antigen (HLA) alleles, form the basis for the additional ambiguities encountered at an increasing rate in clinical practice. HLA-DPB1 characterization, particularly, generates a significant percentage of ambiguities (25.5%), posing a challenge for accurate and unambiguous HLA-DPB1 genotyping. Phasing of exonic heterozygous positions between exon 2 and all other downstream exons has been the major cause of ambiguities. In this study, the Oxford Nanopore MinION, a third-generation sequencing technology, was used to resolve the phasing. The accurate MiSeq sequencing data, combined with the long reads obtained from the MinION platform, allow for the resolution of the tested ambiguities.
Collapse
|
11
|
Single center observation of the role of pre-existing HLA-DP antibodies in humoral rejection following renal transplantation. Transpl Immunol 2018; 51:58-61. [DOI: 10.1016/j.trim.2018.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/11/2018] [Accepted: 09/16/2018] [Indexed: 11/23/2022]
|
12
|
Muthu GS, Mitra S. Algorithm to Quantify the Low and High Resolution HLA Matching in Renal Transplantation. 2018 IEEE 8TH INTERNATIONAL ADVANCE COMPUTING CONFERENCE (IACC) 2018. [DOI: 10.1109/iadcc.2018.8692103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
|
13
|
Mallon DH, Kling C, Robb M, Ellinghaus E, Bradley JA, Taylor CJ, Kabelitz D, Kosmoliaptsis V. Predicting Humoral Alloimmunity from Differences in Donor and Recipient HLA Surface Electrostatic Potential. THE JOURNAL OF IMMUNOLOGY 2018; 201:3780-3792. [PMID: 30429288 PMCID: PMC6287104 DOI: 10.4049/jimmunol.1800683] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/02/2018] [Indexed: 11/27/2022]
Abstract
In transplantation, development of humoral alloimmunity against donor HLA is a major cause of organ transplant failure, but our ability to assess the immunological risk associated with a potential donor–recipient HLA combination is limited. We hypothesized that the capacity of donor HLA to induce a specific alloantibody response depends on their structural and physicochemical dissimilarity compared with recipient HLA. To test this hypothesis, we first developed a novel computational scoring system that enables quantitative assessment of surface electrostatic potential differences between donor and recipient HLA molecules at the tertiary structure level [three-dimensional electrostatic mismatch score (EMS-3D)]. We then examined humoral alloimmune responses in healthy females subjected to a standardized injection of donor lymphocytes from their male partner. This analysis showed a strong association between the EMS-3D of donor HLA and donor-specific alloantibody development; this relationship was strongest for HLA-DQ alloantigens. In the clinical transplantation setting, the immunogenic potential of HLA-DRB1 and -DQ mismatches expressed on donor kidneys, as assessed by their EMS-3D, was an independent predictor of development of donor-specific alloantibody after graft failure. Collectively, these findings demonstrate the translational potential of our approach to improve immunological risk assessment and to decrease the burden of humoral alloimmunity in organ transplantation.
Collapse
Affiliation(s)
- Dermot H Mallon
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge CB2 0QQ, United Kingdom.,National Institute of Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, United Kingdom
| | - Christiane Kling
- Institute for Immunology, University Medical Centre Schleswig-Holstein, Kiel University, 24105 Kiel, Germany
| | - Matthew Robb
- Statistics and Clinical Studies Unit, National Health Service Blood and Transplant, Bristol BS34 7QH, United Kingdom
| | - Eva Ellinghaus
- Institute of Clinical Molecular Biology, University Medical Centre Schleswig-Holstein, Kiel University, 24105 Kiel, Germany; and
| | - J Andrew Bradley
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge CB2 0QQ, United Kingdom.,National Institute of Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, United Kingdom
| | - Craig J Taylor
- National Institute of Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, United Kingdom.,Tissue Typing Laboratory, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Dieter Kabelitz
- Institute for Immunology, University Medical Centre Schleswig-Holstein, Kiel University, 24105 Kiel, Germany
| | - Vasilis Kosmoliaptsis
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; .,National Institute for Health Research Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge CB2 0QQ, United Kingdom.,National Institute of Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, United Kingdom
| |
Collapse
|
14
|
Zachary AA, Leffell MS. HLA Mismatching Strategies for Solid Organ Transplantation - A Balancing Act. Front Immunol 2016; 7:575. [PMID: 28003816 PMCID: PMC5141243 DOI: 10.3389/fimmu.2016.00575] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 11/23/2016] [Indexed: 12/24/2022] Open
Abstract
HLA matching provides numerous benefits in organ transplantation including better graft function, fewer rejection episodes, longer graft survival, and the possibility of reduced immunosuppression. Mismatches are attended by more frequent rejection episodes that require increased immunosuppression that, in turn, can increase the risk of infection and malignancy. HLA mismatches also incur the risk of sensitization, which can reduce the opportunity and increase waiting time for a subsequent transplant. However, other factors such as donor age, donor type, and immunosuppression protocol, can affect the benefit derived from matching. Furthermore, finding a well-matched donor may not be possible for all patients and usually prolongs waiting time. Strategies to optimize transplantation for patients without a well-matched donor should take into account the immunologic barrier represented by different mismatches: what are the least immunogenic mismatches considering the patient’s HLA phenotype; should repeated mismatches be avoided; is the patient sensitized to HLA and, if so, what are the strengths of the patient’s antibodies? This information can then be used to define the HLA type of an immunologically optimal donor and the probability of such a donor occurring. A probability that is considered to be too low may require expanding the donor population through paired donation or modifying what is acceptable, which may require employing treatment to overcome immunologic barriers such as increased immunosuppression or desensitization. Thus, transplantation must strike a balance between the risk associated with waiting for the optimal donor and the risk associated with a less than optimal donor.
Collapse
Affiliation(s)
- Andrea A Zachary
- Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Mary S Leffell
- Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| |
Collapse
|
15
|
Hörmann M, Dieplinger G, Rebellato LM, Briley KP, Bolin P, Morgan C, Haisch CE, Everly MJ. Incidence and impact of anti-HLA-DP antibodies in renal transplantation. Clin Transplant 2016; 30:1108-14. [DOI: 10.1111/ctr.12794] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2016] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Lorita M. Rebellato
- Department of Pathology; Brody School of Medicine at East Carolina University; Greenville NC USA
| | - Kimberly P. Briley
- Department of Pathology; Brody School of Medicine at East Carolina University; Greenville NC USA
| | - Paul Bolin
- Department of Medicine; Brody School of Medicine at East Carolina University; Greenville NC USA
| | - Claire Morgan
- Department of Medicine; Brody School of Medicine at East Carolina University; Greenville NC USA
| | - Carl E. Haisch
- Department of Surgery; Brody School of Medicine at East Carolina University; Greenville NC USA
| | | |
Collapse
|
16
|
Focosi D. Advances in Pretransplant Donor-Specific Antibody Testing in Solid Organ Transplantation: From Bench to Bedside. Int Rev Immunol 2016; 35:351-368. [PMID: 27120091 DOI: 10.3109/08830185.2016.1154051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Immunological risk stratification has a central role in determining both the feasibility of solid organ transplantation and the type (and amount) of induction and maintenance immunosuppressive therapy. Currently there is poor consensus on how to exactly estimate the global immunological risk, and most transplant centers adopt complicated internal guidelines for risk stratification. Here we systematically review published evidences that should drive appropriateness in risk stratification, focusing on donor-specific antibodies against HLA and other antigens.
Collapse
Affiliation(s)
- Daniele Focosi
- a Department of Translational Research , University of Pisa , Pisa , Italy
| |
Collapse
|
17
|
Cross AR, Lion J, Loiseau P, Charron D, Taupin JL, Glotz D, Mooney N. Donor Specific Antibodies are not only directed against HLA-DR: Minding your Ps and Qs. Hum Immunol 2016; 77:1092-1100. [PMID: 27060781 DOI: 10.1016/j.humimm.2016.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/08/2016] [Accepted: 04/04/2016] [Indexed: 12/30/2022]
Abstract
During solid organ transplantation, interactions between recipient and donor immune cells occur chiefly in the allograft microvasculature. All three HLA class II antigens, DR, DP and DQ, have been detected on renal EC with a markedly increased expression of HLA class II observed in renal allografts undergoing rejection. Recent studies of donor-specific antibodies (DSA) have exposed the prevalence of de novo DSA directed against HLA-DQ, as well as a strong association between these antibodies and allograft damage. The HLA-DQ molecule can be distinguished from the other class II antigens by its transcription, expression and peptide repertoire. The distinct intragraft expression and immunogenicity of HLA-DQ may contribute to the incidence of HLA-DQ DSA, as well as directing the DSA-mediated damage. The possibility of HLA class II antigen-specific signaling in EC may reveal different mechanisms of allograft damage that act in tandem with complement-dependent injury. This review addresses the features of the HLA-DQ heterodimer that may underlie the high incidence of HLA-DQ directed DSA and their association with allograft damage. We also consider existing data in hematopoietic stem cell transplantation concerning HLA directed DSA.
Collapse
Affiliation(s)
- Amy R Cross
- INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Hôpital Saint Louis, Paris 75010, France; LabEx Transplantex, AP-HP, Hôpital Saint-Louis, Paris 75010, France
| | - Julien Lion
- INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Hôpital Saint Louis, Paris 75010, France; LabEx Transplantex, AP-HP, Hôpital Saint-Louis, Paris 75010, France
| | - Pascale Loiseau
- INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Hôpital Saint Louis, Paris 75010, France; LabEx Transplantex, AP-HP, Hôpital Saint-Louis, Paris 75010, France; Laboratoire de Histocompatibilité, Hôpital Saint Louis, Paris 75010, France
| | - Dominique Charron
- Laboratoire de Histocompatibilité, Hôpital Saint Louis, Paris 75010, France; Université Paris Diderot, Sorbonne Paris Cité, F-75013, France
| | - Jean-Luc Taupin
- INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Hôpital Saint Louis, Paris 75010, France; LabEx Transplantex, AP-HP, Hôpital Saint-Louis, Paris 75010, France; Laboratoire de Histocompatibilité, Hôpital Saint Louis, Paris 75010, France; Université Paris Diderot, Sorbonne Paris Cité, F-75013, France
| | - Denis Glotz
- INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Hôpital Saint Louis, Paris 75010, France; LabEx Transplantex, AP-HP, Hôpital Saint-Louis, Paris 75010, France; Service de Néphrologie et Transplantation, Hôpital Saint Louis, Paris 75010, France; Université Paris Diderot, Sorbonne Paris Cité, F-75013, France
| | - Nuala Mooney
- INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Hôpital Saint Louis, Paris 75010, France; LabEx Transplantex, AP-HP, Hôpital Saint-Louis, Paris 75010, France.
| |
Collapse
|
18
|
Redondo-Pachón D, Pascual J, Pérez-Sáez MJ, García C, Hernández JJ, Gimeno J, Mir M, Crespo M. Impact of preformed and de novo anti-HLA DP antibodies in renal allograft survival. Transpl Immunol 2015; 34:1-7. [PMID: 26603314 DOI: 10.1016/j.trim.2015.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/12/2015] [Accepted: 11/17/2015] [Indexed: 11/26/2022]
Abstract
The influence of antibodies against HLA-DP antigens detected with solid-phase assays on graft survival after kidney transplantation (KT) is uncertain. We evaluated with Luminex® the prevalence of pre- and posttransplant DP antibodies in 440 KT patients and their impact on graft survival. For 291 patients with available pretransplant samples, DP antibodies were present in 39.7% KT with pretransplant HLA antibodies and 47.7% with DSA. Graft survival of KT with pretransplant class-II DSA was worse than with non-DSA (p=0.01). DP antibodies did not influence graft survival. Of 346 patients monitored post-KT, 17.1% had HLA class-II antibodies, 56% with DP antibodies. Class-II DSA was detected in 39%, 60.9% of them had DP antibodies. Graft survival was worse in patients with class-II DSA (p=0.022). DP antibodies did not change these results. The presence of isolated DP antibodies was a rare event both pre- and posttransplantation (1.03 and 0.86%). The presence of pretransplant and posttransplant DSA is associated with a negative impact on graft survival. However, the presence of DP antibodies does not modify this impact significantly.
Collapse
Affiliation(s)
- Dolores Redondo-Pachón
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, Barcelona, Spain.
| | - María J Pérez-Sáez
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, Barcelona, Spain
| | - Carmen García
- Laboratori de Referencia de Catalunya, Barcelona, Spain
| | | | - Javier Gimeno
- Department of Pathology, Hospital del Mar, Barcelona, Spain
| | - Marisa Mir
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, Barcelona, Spain
| | - Marta Crespo
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, Barcelona, Spain
| |
Collapse
|
19
|
Filippone EJ, Farber JL. Humoral immunity in renal transplantation: epitopes, Cw and DP, and complement-activating capability - an update. Clin Transplant 2015; 29:279-87. [DOI: 10.1111/ctr.12524] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Edward J. Filippone
- Division of Nephrology; Department of Medicine; Thomas Jefferson University Hospital; Philadelphia PA USA
| | - John L. Farber
- Department of Pathology; Thomas Jefferson University Hospital; Philadelphia PA USA
| |
Collapse
|
20
|
Mehrotra S, Sharma R, Mayya M, Gupta A, Prasad N, Kaul A, Bhadauria D. Pre transplant PRA (penal reactive antibody) and DSA (donor specific antibody) screening status and outcome after renal transplantation. INDIAN JOURNAL OF TRANSPLANTATION 2015. [DOI: 10.1016/j.ijt.2015.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
21
|
The Maastricht Transplant Center: Clinical setting and epitope searches in HLA class II molecules: Does the structural localization of a polymorphic site contribute to its immunogenicity? Transpl Immunol 2014; 31:213-8. [DOI: 10.1016/j.trim.2014.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 09/08/2014] [Indexed: 11/18/2022]
|
22
|
Gilbert M, Paul S, Perrat G, Giannoli C, Pouteil Noble C, Morelon E, Rigal D, Dubois V. Impact of pretransplant human leukocyte antigen-C and -DP antibodies on kidney graft outcome. Transplant Proc 2014; 43:3412-4. [PMID: 22099809 DOI: 10.1016/j.transproceed.2011.09.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aim of our study was to determine whether the presence of specific human leukocyte antigen (HLA)-C and -DP antibodies before transplantation influenced graft outcomes in immunized recipients. Two groups of pretransplant immunized recipients were studied: patients with only classical HLA-A, -B, -DR, -DQ antibodies (n = 176) and those with classical plus HLA-C and/or -DP antibodies (n = 27). Acute antibody-mediated rejection was preferentially associated with the presence of pretransplant anti-HLA-C and -DP antibodies (5/6 cases). In four cases, acute rejection episodes were followed by graft loss within 15 months after transplantation. There was a significant increase in the number of acute rejection episodes especially antibody-mediated acute rejections (P = .036) and in the number of graft losses for immunologic reasons (P < .001) among the group with pretransplant anti-C and -DP antibodies. Pretransplant anti-DP antibodies seemed to be involved more frequently in poor graft outcomes as shown in several recent published cases. We need to investigate their specific role among a larger cohort, taking into account an epitope analysis.
Collapse
Affiliation(s)
- M Gilbert
- Histocompatibility Laboratory, Etablissement Français du Sang Rhône-Alpes, Lyon, France
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Identification of patients with increased immunological risk among potential kidney recipients in the Polish population. Hum Immunol 2014; 75:650-5. [DOI: 10.1016/j.humimm.2014.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/14/2014] [Accepted: 04/06/2014] [Indexed: 01/02/2023]
|
24
|
Mierzejewska B, Schroder PM, Baum CE, Blair A, Smith C, Duquesnoy RJ, Marrari M, Gohara A, Malhotra D, Kaw D, Liwski R, Rees MA, Stepkowski S. Early acute antibody-mediated rejection of a negative flow crossmatch 3rd kidney transplant with exclusive disparity at HLA-DP. Hum Immunol 2014; 75:703-8. [PMID: 24755353 DOI: 10.1016/j.humimm.2014.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 02/27/2014] [Accepted: 04/05/2014] [Indexed: 02/02/2023]
Abstract
Donor-specific alloantibodies (DSA) to HLA-DP may cause antibody-mediated rejection (AMR), especially in re-transplants. We describe the immunization history of a patient who received 3 kidney transplants; the 3rd kidney was completely matched except at DPA1 and DPB1. Prior to the 3rd transplant, single antigen bead analysis (SAB) showed DSA reactivity against DPA1 shared by the 1st and 3rd donors, but B and T flow crossmatch (FXM) results were negative. Within 11 days the 3rd transplant underwent acute C4d+ AMR which coincided with the presence of complement (C1q)-binding IgG1 DSA against donor DPA1 and DPB1. Using HLAMatchmaker and SAB, we provide evidence that eplet (epitope) spreading on DPA1 and eplet sharing on differing DPB1 alleles of the 1st and 3rd transplants was associated with AMR. Since weak DSA to DPA1/DPB1 may induce acute AMR with negative FXM, donor DPA1/DPB1 high resolution typing should be considered in sensitized patients with DP-directed DSA.
Collapse
Affiliation(s)
- Beata Mierzejewska
- Department of Urology, University of Toledo College of Medicine, Toledo, OH 43614, USA
| | - Paul M Schroder
- Department of Microbiology and Immunology, University of Toledo College of Medicine, Toledo, OH 43614, USA
| | - Caitlin E Baum
- Department of Microbiology and Immunology, University of Toledo College of Medicine, Toledo, OH 43614, USA
| | - Annette Blair
- Department of Pathology, University of Toledo College of Medicine, Toledo, OH 43614, USA
| | - Connie Smith
- Department of Pathology, University of Toledo College of Medicine, Toledo, OH 43614, USA
| | - Rene J Duquesnoy
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Marilyn Marrari
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Amira Gohara
- Department of Pathology, University of Toledo College of Medicine, Toledo, OH 43614, USA
| | - Deepak Malhotra
- Department of Internal Medicine, University of Toledo College of Medicine, Toledo, OH 43614, USA
| | - Dinkar Kaw
- Department of Internal Medicine, University of Toledo College of Medicine, Toledo, OH 43614, USA
| | - Robert Liwski
- HLA Typing Laboratory, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael A Rees
- Department of Urology, University of Toledo College of Medicine, Toledo, OH 43614, USA
| | - Stanislaw Stepkowski
- Department of Microbiology and Immunology, University of Toledo College of Medicine, Toledo, OH 43614, USA.
| |
Collapse
|
25
|
ERBP Guideline on the Management and Evaluation of the Kidney Donor and Recipient. Nephrol Dial Transplant 2014; 28 Suppl 2:ii1-71. [PMID: 24026881 DOI: 10.1093/ndt/gft218] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
26
|
Late antibody-mediated rejection by de novo donor HLA-DP-specific antibody after renal transplantation: a case report. Hum Immunol 2014; 75:462-5. [PMID: 24530822 DOI: 10.1016/j.humimm.2014.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 01/03/2014] [Accepted: 02/04/2014] [Indexed: 12/27/2022]
Abstract
The role of donor HLA-DP-specific antibodies after renal transplantation is controversial, and only preformed HLA-DP-specific antibodies have been shown to mediate rejection. Here we present a case of late humoral rejection mediated by de novo donor HLA-DP-specific antibodies in a non-sensitized recipient. This unique case demonstrates the pathogenic role of de novo anti-DP antibodies and suggests that HLA-DP matching might be relevant for renal transplantation.
Collapse
|
27
|
Süsal C, Roelen DL, Fischer G, Campos EF, Gerbase-DeLima M, Hönger G, Schaub S, Lachmann N, Martorell J, Claas F. Algorithms for the determination of unacceptable HLA antigen mismatches in kidney transplant recipients. ACTA ACUST UNITED AC 2013; 82:83-92. [PMID: 23718733 DOI: 10.1111/tan.12137] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
One of the major tasks of human leukocyte antigen (HLA) laboratories is the pretransplant determination of unacceptable HLA antigen mismatches (UAM) in organ transplant recipients. HLA antigen specificities are determined against which the patient has circulating alloantibodies that are expected to harm the transplanted organ. Using the information on UAM, negative crossmatch (XM) prediction or 'virtual XM' is possible when a potential donor's complete HLA typing is available. Before the introduction of solid-phase antibody detection assays, UAM were determined using the complement-dependent cytotoxicity methodology. After the introduction of the single antigen bead technique, however, various UAM determination algorithms have emerged. In this report, six different laboratories worldwide present how they determine UAM in their collective of kidney transplant recipients in the pretransplant phase and proceed thereafter to transplantation.
Collapse
Affiliation(s)
- C Süsal
- Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Deleterious Impact of HLA-DRB1 Allele Mismatch in Sensitized Recipients of Kidney Retransplants. Transplantation 2013. [DOI: 10.1097/tp.0b013e318277e277] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Jolly EC, Key T, Rasheed H, Morgan H, Butler A, Pritchard N, Taylor CJ, Clatworthy MR. Preformed donor HLA-DP-specific antibodies mediate acute and chronic antibody-mediated rejection following renal transplantation. Am J Transplant 2012; 12:2845-8. [PMID: 22759079 PMCID: PMC4143589 DOI: 10.1111/j.1600-6143.2012.04172.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Donor-specific HLA alloantibodies may cause acute and chronic antibody-mediated rejection (AMR) and significantly compromise allograft survival. The clinical relevance of antibodies directed against some HLA class II antigens, particularly HLA-DP, is less clear with conflicting reports on their pathogenicity. We report two patients with high levels of pretransplant donor-specific HLA-DP antibodies who subsequently developed recurrent acute AMR and graft failure. In both cases, there were no other donor-specific HLA alloantibodies, suggesting that the HLA-DP-specific antibodies may be directly pathogenic.
Collapse
Affiliation(s)
- E. C. Jolly
- Division of Renal Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - T. Key
- Tissue Typing Laboratory, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
| | - H. Rasheed
- Division of Renal Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - H. Morgan
- Tissue Typing Laboratory, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
| | - A. Butler
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Hills Road, Cambridge, UK
| | - N. Pritchard
- Division of Renal Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - C. J. Taylor
- Tissue Typing Laboratory, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
| | - M. R. Clatworthy
- Division of Renal Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
30
|
Acute humoral rejection in a zero mismatch deceased donor renal transplant due to an antibody to an HLA-DP alpha. Transplantation 2010; 90:220-1. [PMID: 20644454 DOI: 10.1097/tp.0b013e3181e1177d] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
31
|
Billen EVA, Christiaans MHL, Doxiadis IIN, Voorter CEM, van den Berg-Loonen EM. HLA-DP antibodies before and after renal transplantation. ACTA ACUST UNITED AC 2010; 75:278-85. [DOI: 10.1111/j.1399-0039.2009.01428.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
32
|
Acceptable Donor-Specific Antibody Levels Allowing for Successful Deceased and Living Donor Kidney Transplantation After Desensitization Therapy. Transplantation 2008; 86:820-5. [DOI: 10.1097/tp.0b013e3181856f98] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Sindhi R, Higgs BW, Weeks DE, AshokKumar C, Jaffe R, Kim C, Wilson P, Chien N, Glessner J, Talukdar A, Mazariegos G, Barmada MM, Frackleton E, Petro N, Eckert A, Hakonarson H, Ferrell R. Genetic variants in major histocompatibility complex-linked genes associate with pediatric liver transplant rejection. Gastroenterology 2008; 135:830-9, 839.e1-10. [PMID: 18639552 PMCID: PMC2956436 DOI: 10.1053/j.gastro.2008.05.080] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 04/30/2008] [Accepted: 05/21/2008] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS Limited access to large samples precludes genome-wide association studies of rare but complex traits. To localize candidate genes with family-based genome-wide association, a novel exploratory analysis was first tested on 1774 major histocompatibility complex single nucleotide polymorphisms (SNPs) in 240 DNA samples from 80 children with primary liver transplantation and their biologic parents. METHODS Initially, 57 SNPs with large differences (P < .05) in minor allele frequencies were selected when parents of children with early rejection (rejectors) were compared with parents of nonrejectors. RESULTS In hypothesis testing of selected SNPs, the gamete competition statistic identified the minor allele G of the SNP rs9296068, near HLA-DOA, as being significantly different (P = .018) between outcome groups in parent-to-child transmission. Subsequent simple association testing confirmed over- and undertransmission of rs9296068 based on the most significant differences between outcome groups, of 1774 SNPs tested (P = .002), and allele (G) frequencies that were greater among rejectors (51.4% vs 36.8%, respectively, P = .015) and lower among nonrejectors (26.8% vs 36.8%, respectively, P = .074) compared with 400 normal control Caucasian children. In early functional validation, rejectors demonstrated significant repression of the first HLA-DOA exon closest to rs9296068. Also, intragraft B lymphocytes, whose antigen-presenting function is selectively inhibited by HLA-DOA were 3-fold more numerous during rejection among rejectors with the risk allele, than those without. CONCLUSIONS The minor allele of the SNP rs9296068 is significantly associated with liver transplantation rejection and with enhanced B-lymphocyte participation in rejection, likely because of a dysfunctional HLA-DOA gene product.
Collapse
Affiliation(s)
- Rakesh Sindhi
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Praticò-Barbato L, Conca R, Magistroni P, Leonardi G, Oda A, Rosati F, Leone E, Tacconella M, Roggero S, Segoloni GP, Amoroso A. B cell positive cross-match not due to anti-HLA Class I antibodies and first kidney graft outcome. Transpl Immunol 2008; 19:238-43. [DOI: 10.1016/j.trim.2008.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 05/07/2008] [Accepted: 05/13/2008] [Indexed: 11/16/2022]
|
35
|
Duquesnoy RJ, Awadalla Y, Lomago J, Jelinek L, Howe J, Zern D, Hunter B, Martell J, Girnita A, Zeevi A. Retransplant candidates have donor-specific antibodies that react with structurally defined HLA-DR,DQ,DP epitopes. Transpl Immunol 2008; 18:352-60. [PMID: 18158123 PMCID: PMC2724998 DOI: 10.1016/j.trim.2007.10.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 10/04/2007] [Indexed: 10/22/2022]
Abstract
This report describes a detailed analysis how donor-specific HLA class II epitope mismatching affects antibody reactivity patterns in 75 solid organ transplant recipients with an in situ allograft and who were considered for retransplantation. Sera were tested for antibodies in a sensitive antigen-binding assay (Luminex) with single class II alleles. Their reactivity was analyzed with HLAMatchmaker, a structural matching algorithm that considers so-called eplets to define epitopes recognized by antibodies. Only 24% of the patients showed donor-specific anti-DRB1 antibodies and there was a significant correlation with a low number of mismatched DRB1 eplets. This low detection rate of anti-DRB1 antibodies may also be due to allograft absorption. In contrast, antibodies to DRB3/4/5 mismatches were more common. Especially, 83% of the DRB4 (DR53) mismatches resulted in detectable antibodies against an eplet uniquely found on DR53 antigens. Donor-specific DQB mismatches led to detectable anti-DQB antibodies with a frequency of 87%. Their specificity correlated with eplets uniquely found on DQ1-4. The incidence of antibodies induced by 2-digit DQA mismatches was 64% and several eplets appeared to play a dominant role. These findings suggest that both alpha and beta chains of HLA-DQ heterodimers have immunogenic epitopes that can elicit specific antibodies. About one-third of the sera had anti-DP antibodies; they reacted primarily with two DPB eplets and an allelic pair of DPA eplets. These data demonstrate that HLA class II reactive sera display distinct specificity patterns associated with structurally defined epitopes on different HLA-D alleles.
Collapse
Affiliation(s)
- Rene J Duquesnoy
- Division of Transplantation Pathology and Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
DP reactive antibody in a zero mismatch renal transplant pair. Hum Immunol 2007; 68:947-9. [DOI: 10.1016/j.humimm.2007.10.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 10/18/2007] [Accepted: 10/18/2007] [Indexed: 11/21/2022]
|
37
|
House AA, Chang PCW, Luke PP, Leckie SH, Howson WT, Ball EJ, Tan AKL, Rehman F, Muirhead N, Hollomby DJ, McAlister VC, Hodsman AB, Jevnikar AM. Re-exposure to mismatched HLA class I is a significant risk factor for graft loss: multivariable analysis of 259 kidney retransplants. Transplantation 2007; 84:722-8. [PMID: 17893605 DOI: 10.1097/01.tp.0000281398.41670.1f] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kidney retransplants carry increased immunologic risk. One possible contributor to this risk may be re-exposure to human leukocyte antigens (HLA) common to a previous donor but foreign to the recipient. Conflicting publications have assessed this risk, so to examine our experience 259 kidney retransplants were analyzed. METHODS A retrospective cohort of retransplant patients from 1973 to 2005 with minimum 12 months follow up was examined. Using multivariable modeling, important confounders were controlled for identifying factors significantly affecting graft survival. RESULTS Re-exposure to HLA class I (HLA-A or B) antigens, peak panel reactive antibodies and donor source were the most important determinants of allograft survival, despite a negative conventional or anti-human globulin-augmented T cell crossmatch. We failed to demonstrate that recipient re-exposure to HLA class II (HLA-DR) or positive B cell crossmatch were associated with adverse outcomes. Sample size and molecular versus serologic methods may have influenced the former, while inability to determine antibody specificities may have influenced the latter. Controlling for other variables, the adjusted risk of graft loss associated with re-exposure to HLA class I increased by 71% (P=0.006) and occurred early, consistent with recall of memory cytotoxic T lymphocyte or antibody responses. CONCLUSIONS Kidney recipients re-exposed to mismatched HLA class I antigens appear to be at heightened risk of early graft loss. Such patients may benefit from pretransplant identification of donor specific antibodies using solid phase methods and heightened vigilance for acute rejection. Future studies may indicate whether more intensive immunosuppression for these patients is warranted.
Collapse
Affiliation(s)
- Andrew A House
- Multi-Organ Transplant Program, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Duquesnoy RJ, Askar M. HLAMatchmaker: a molecularly based algorithm for histocompatibility determination. V. Eplet matching for HLA-DR, HLA-DQ, and HLA-DP. Hum Immunol 2007; 68:12-25. [PMID: 17207708 PMCID: PMC2527859 DOI: 10.1016/j.humimm.2006.10.003] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 09/12/2006] [Accepted: 10/02/2006] [Indexed: 10/24/2022]
Abstract
This report describes the design of the eplet version of HLAMatchmaker to determine class II compatibility at the structural level. This matching algorithm is based on the hypothesis, developed from molecular modeling of crystallized antigen-antibody complexes, that functional epitopes are represented by patches of surface-exposed nonself-amino acid residues surrounded by residues within a 3-A radius. Patch determinations with a molecular viewer of crystalline structural models downloaded from the Entrez Molecular Modeling Database Web site led to the identification of 44 DRB, 33DQB, 29 DQA, 20 DPB, and 9 DPA unique combinations of polymorphic positions. The residue compositions of these patches were then determined from amino acid sequences. This analysis resulted in a repertoire of 146 DRB, 74 DQB, 58 DQA, 45 DPB, and 19 DPA eplets. In many eplets, the residues are in short linear sequences, but many other eplets have discontinuous sequences of residues that cluster on or near the molecular surface. This analysis has also shown that all serologically defined DR and DQ antigens detectable by monospecific antibodies have unique eplets. Other eplets are present in groups of class II antigens, many of which appear as cross-reacting. The eplet version of HLAMatchmaker should be considered as a hypothetical model for the structural assessment of donor-recipient compatibility and the determination of mismatch acceptability for sensitized patients. This computer algorithm can be downloaded from the HLA Matchmaker Webside at http://tpis.upmc.edu.
Collapse
Affiliation(s)
- Rene J Duquesnoy
- Division of Transplantation Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA.
| | | |
Collapse
|
39
|
Yagmurdur MC, Emiroğlu R, Ayvaz I, Sozen H, Karakayali H, Haberal M. The effect of graft nephrectomy on long-term graft function and survival in kidney retransplantation. Transplant Proc 2006; 37:2957-61. [PMID: 16213273 DOI: 10.1016/j.transproceed.2005.07.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We retrospectively evaluated the long-term results of 53 (3.5%) recipients who received second allograft among 1486 kidney transplants between November 3, 1975 and June 30, 2004. Two study groups were patients in Group 1 (n = 21) who underwent allograft nephrectomy and those in Group 2 (n = 32) who did not. We assessed demographic features, rejection rates throughout the follow-up period, and serum creatinine levels at 12 months as well as graft and patient survival rates, postoperative complications, time interval between transplantations, and HLA matches. Forty-three patients who underwent retransplantation received kidneys from living-related donors and the remaining 10 from cadaveric donors. Mean serum creatinine levels of Group 1 versus Group 2 were 1.8 mg/dL (range, 0.8 to 6.6 mg/dL) versus 2.1 +/- 1.1 mg/dL (range, 1.1 to 7.1 mg/dL). HLA-AB and HLA-DR mismatches were 1.9 +/- 1.1 versus 1 +/- 0.6, respectively (P = .01). Acute rejection rates were not significantly different between Groups 1 (9/21, 43%) and 2 (12/32, 38%) (P < .05). The average intervals between the first and the second transplantations were 62 +/- 26 months in Group 1 (P = .02) and 32 +/- 11 months in Group 2. One-, 3-, and 5-year graft survival rates in Group 1 versus Group 2 were 83% versus 89% (P > .05); 64% versus 79% (P > .05), and 45% versus 68% (P = .04), respectively. In conclusion, we did not observe any advantage of graft nephrectomy before retransplantation. The length of the interval between the first and the second transplantations may have a negative correlation with second graft survival.
Collapse
Affiliation(s)
- M C Yagmurdur
- Baskent University Faculty of Medicine, Department of General Surgery Division of Transplantation, Ankara Turkey
| | | | | | | | | | | |
Collapse
|
40
|
Qiu J, Cai J, Terasaki PI, El-Awar N, Lee JH. Detection of Antibodies to HLA-DP in Renal Transplant Recipients Using Single Antigen Beads. Transplantation 2005; 80:1511-3. [PMID: 16340798 DOI: 10.1097/01.tp.0000181384.49832.3a] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
With the development of single DP-antigen beads, antibodies to DP could clearly be segregated from other HLA antibodies. We studied 323 sera of patients from four different centers with functioning or rejected kidney grafts. DP antibodies were found in 5.1% of 138 patients with functioning grafts, and 19.5 % of 185 patients with rejected grafts (P<0.001)). 42.9% and 63.9% of the DP antibody positive patients had DR/DQ antibodies among the functioning and rejected group. Among patients who did not have Class I and DR/DQ antibodies, 13% of those who rejected a graft had DP antibodies, compared to 3.5% of patients with functioning grafts (P<0.05). DP 0301 had the highest specificity frequency in the rejected group. In conclusion, HLA-DP antibodies were detected at a higher frequency in patients who have rejected their grafts than those with functioning grafts. For regrafts, DP tissue typing is recommended to avoid presensitized DP alleles.
Collapse
Affiliation(s)
- Jianxin Qiu
- Terasaki Foundation Laboratory, Los Angeles, CA 90064, USA
| | | | | | | | | |
Collapse
|
41
|
Arnold ML, Pei R, Spriewald B, Wassmuth R. Anti-HLA class II antibodies in kidney retransplant patients. ACTA ACUST UNITED AC 2005; 65:370-8. [PMID: 15787721 DOI: 10.1111/j.1399-0039.2005.00382.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The relevance of anti-HLA class II antibodies for kidney graft survival is still controversial. In part, this can be attributed to difficulties to detect and differentiate anti-HLA class II antibodies. Anti-HLA class II IgG antibody screening was performed by enzyme-linked immunosorbent assay. Subsequently, all anti-HLA class II-positive sera were subjected to the determination and specification using color-coded microspheres coated with purified HLA antigens. In a cohort of 934 patients awaiting kidney transplantation, 41 sera (4.4%) were positive for IgG anti-HLA class II antibodies. The presence was confirmed in 90.2% sera by retesting. Subsequently, all anti-HLA class II-positive patients (n = 27) who in the past had undergone a kidney transplantation with an HLA-DR and/or -DQ-mismatched graft were selected. In 25 of 27 sera (92.6%), the alloantibody specificities corresponded to the known previous transplant mismatches on a broad antigen level. In 20 of 27 sera (74.1%), anticlass I antibodies were detected as well. Anti-HLA-DP antibodies were seen in 24 of the 27 sera of this cohort. In the majority of the cases, the reactivities with different DPB1 alleles could be explained by involvement of a single, specific DPB1 epitope. Donor-specific anti-HLA-DR and -DQ antibodies were seen in the majority of cases with graft failure following HLA class II alloantigen exposure in prior kidney transplantations. In addition, HLA-DP may serve as a transplantation antigen in kidney transplantation, leading to a humoral response.
Collapse
Affiliation(s)
- M-L Arnold
- Institute for Clinical Immunology and Department of Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | | | | | | |
Collapse
|
42
|
Takemoto S, Port FK, Claas FHJ, Duquesnoy RJ. HLA matching for kidney transplantation. Hum Immunol 2005; 65:1489-505. [PMID: 15603878 DOI: 10.1016/j.humimm.2004.06.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Accepted: 06/17/2004] [Indexed: 12/24/2022]
|
43
|
Mytilineos J, Laux G, Opelz G. Relevance of IL10, TGFbeta1, TNFalpha, and IL4Ralpha gene polymorphisms in kidney transplantation: a collaborative transplant study report. Am J Transplant 2004; 4:1684-90. [PMID: 15367225 DOI: 10.1111/j.1600-6143.2004.00561.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Single nucleotide polymorphisms (SNPs) of cytokine genes have been shown to influence cytokine plasma levels. Cytokines are important mediators during organ graft rejection. It was reported that certain cytokine genotypes are associated with improved kidney graft survival. In the present study, SNPs within the IL10 promoter gene, the first exon of the TGFbeta1 gene, the TNFalpha promoter gene, and the IL4Ralpha gene were analyzed in 2298 first and 1901 repeat cadaver kidney recipients. We found no significant effect on the survival rate of first grafts. Among retransplants, we observed that recipients who were homozygous for the high TNFalpha producer genotype -308 A had a significantly lower graft survival rate than patients who were carriers of the low producer genotype -308 G (at 3 years: 63.0% vs. 79.5%; pcorrected = 0.0116). The results of this large-scale study suggest that IL10, TGFbeta1, TNFalpha, and IL4Ralpha cytokine genotypes do not affect the survival of primary kidney grafts. The outcome of retransplants appears to be affected by TNFalpha genotypes only.
Collapse
Affiliation(s)
- Joannis Mytilineos
- Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany.
| | | | | |
Collapse
|
44
|
Rees MT, Darke C. HLA-A, B, C, DRB1, DQB1 matching heterogeneity in ‘favourably matched’ kidney recipients. Transpl Immunol 2003; 12:73-8. [PMID: 14551034 DOI: 10.1016/s0966-3274(03)00017-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Allocation of cadaveric donor kidneys in the UK is founded on matching for HLA-A, -B and -DR, primarily at the broad specificity level. Increasing evidence shows that matching at a higher resolution and consideration of additional loci, such as HLA-C, -DQ and -DP, improves graft outcome. The aim of this study was to clarify the typical level of split specificity HLA-A, -B, -C, -DR, -DQ and allelic -DRB1 and -DQB1 mismatching in 'favourably matched' cadaveric renal transplant pairs. Two hundred and thirty-seven cadaveric donor/recipient pairs, 'favourably matched', according to United Kingdom Transplant criteria, were typed at the split specificity level for HLA-A, -B, -C and at the allele level for HLA-DRB1 and -DQB1. The level of split specificity and allele mismatching was then assessed. Overall, 66.7% of the patients had at least one HLA-C mismatch with their donors; 36.9% of those matched for HLA-B and 85.5% of those mismatched for HLA-B (P<0.0001). A broad specificity HLA-A or -B mismatch influenced the presence of an HLA-B, or HLA-A split specificity mismatch, respectively, (P<0.05) but made no significant difference to the presence of an HLA-DR split mismatch. Overall, 4.6% of the patients were mismatched for HLA-DR split specificities but 30.4% were mismatched at HLA-DQ and 50.6% had at least one HLA-DRB1 or -DQB1 allele mismatch. Considerable HLA-A, -B, -C, -DR, -DQ matching heterogeneity exists even amongst 'well matched' renal transplant patient groups. Little is known about the effects of combinations of mismatched specificities on graft survival. Thus, further investigation is merited particularly for HLA-C and -DQ mismatching.
Collapse
Affiliation(s)
- M T Rees
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Ely Valley Road, Talbot Green, Pontyclun CF72 9WB, Wales, UK.
| | | |
Collapse
|
45
|
Laux G, Mansmann U, Deufel A, Opelz G, Mytilineos J. A new epitope-based HLA-DPB matching approach for cadaver kidney retransplants. Transplantation 2003; 75:1527-32. [PMID: 12792509 DOI: 10.1097/01.tp.0000061759.57702.8a] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several years ago a significant impact of matching for HLA-DPB1 alleles on the survival of cadaver kidney retransplants was shown. Here we report the results of a new approach, based on matching for HLA-DPB1 epitopes. METHODS The analysis is based on 1,478 patients who received a cadaver kidney retransplant between 1988 and 1998. DNA methodology (polymerase chain reaction, sequence-specific oligonucleotides) was used to perform HLA-DPB1 typing. Epitope matching was facilitated with the aid of sequence databases and computer calculations. RESULTS Matching for the HLA-DP epitopes A, B, E, and F, corresponding to the homonymous hypervariable regions of the second exon of the DPB1 gene, seems to have a greater influence on graft survival than matching for the epitopes C and D. Within a group of 529 retransplants with exactly one allelic HLA-DPB1 mismatch, a significantly better graft outcome was observed when less than two epitope mismatches were found, compared with the group with more than three epitope mismatches (at 2 years: 77.8% vs. 65.8%, P=0.0112). Importantly, patients with two DPB1 allele mismatches who had less than or equal to two epitope mismatches exhibited a significantly better graft outcome than recipients who had one HLA-DPB1 allelic mismatch but more than three epitope mismatches (at 2 years: 77.1% vs. 65.8%, P=0.0488). CONCLUSIONS The findings indicate that the impact of HLA-DPB1 matching on the outcome of kidney retransplants is a result of the predominant immunogenicity of certain epitopes of the HLA-DP molecule. Matching for immunogenic HLA-DPB1 epitopes seems to be functionally more relevant than classical matching at the allelic level.
Collapse
Affiliation(s)
- Gunter Laux
- Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Germany.
| | | | | | | | | |
Collapse
|
46
|
Büchler T, Gallardo D, Rodríguez-Luaces M, Pujal JM, Grañena A. Frequency of HLA-DPB1 disparities detected by reference strand-mediated conformation analysis in HLA-A, -B, and -DRB1 matched siblings. Hum Immunol 2002; 63:139-42. [PMID: 11821161 DOI: 10.1016/s0198-8859(01)00376-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The role of HLA-DPB1 as transplantation antigen is controversial. The frequency and relevance of HLA-DPB1 mismatch in hematopoietic stem cell transplantation are unknown. To ascertain the rate of HLA-DBP1 mismatch in siblings that had been matched for HLA-A, -B, and -DRB1, reference strand mediated conformation analysis (RSCA) a high resolution HLA typing method was used. Locus-specific primers were used to amplify the HLA-DPB1 locus. The PCR product was then hybridized with two fluorescein-labeled references and the duplexes were analyzed after electrophoresis in a short polyacrylamide gel. Among the 113 pairs of individuals tested, six HLA-DPB1 mismatches were identified, which corresponds to a frequency of 5.31 % (95% confidence interval 3.20%-7.42 %).
Collapse
Affiliation(s)
- T Büchler
- Alloreactivity Unit, Department of Clinical Hematology, Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
| | | | | | | | | |
Collapse
|
47
|
Velickovic ZM, Carter JM. HLA-DPA1 and DPB1 polymorphism in four Pacific Islands populations determined by sequencing based typing. TISSUE ANTIGENS 2001; 57:493-501. [PMID: 11556979 DOI: 10.1034/j.1399-0039.2001.057006493.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Class II HLA-DP antigens are heterodimers comprised of alpha and beta chains coded by HLA-DPA1 and HLA-DPB1 genes. Both genes are polymorphic with substantial variation between different populations world wide. This work describes DPA1 and DPB1 polymorphism in four Pacific Island populations of Cook Islands, Samoa, Tokelau and Tonga, living in New Zealand. Using sequencing based typing four DPA1 alleles and twelve DPB1 alleles were observed in total among the four populations. There are two predominant DPA1 alleles DPA1*01031 and DPA1*02022 and three predominant DPB1 alleles DPB1*02012, DPB1*0401 and DPB1*0501. Fourteen DPA1-DPB1 haplotypes in total are present in these four populations with three predominant haplotypes: DPA1*02022-DPB1*0501, DPA1*01031-DPB1*02012, and DPA1*01031-DPB1*0401. Strong positive and negative disequilibrium was observed for individual DPA1-DPB1 haplotypes. Significant differences in DPA1 and DPB1 allele and haplotype frequencies were observed between Tokelauan and other three populations. Phylogenetic analysis of genetic distances between the four Pacific Island populations and other Asian Oceanian populations have shown that Cook Islanders, Samoans and Tongans are more closely related to Asian populations whereas Tokelauans cluster towards non-Austronesian populations of Papua New Guinea Highlanders and Australian Aborigines.
Collapse
Affiliation(s)
- Z M Velickovic
- Department of Pathology and Molecular Medicine, Wellington School of Medicine, Wellington, New Zealand.
| | | |
Collapse
|
48
|
Affiliation(s)
- H A Erlich
- Roche Molecular Systems, Alameda, CA 94501, USA.
| | | | | |
Collapse
|
49
|
Aldener-Cannavá A, Olerup O. HLA-DPB1 typing by polymerase chain reaction amplification with sequence-specific primers. TISSUE ANTIGENS 2001; 57:287-99. [PMID: 11380937 DOI: 10.1034/j.1399-0039.2001.057004287.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
DPB1 is the second most polymorphic class II locus with currently 84 recognized alleles, i.e. DPB1*0101 to DPB1*8101. Most of the alleles have been described during the last few years using oligonucleotide and sequencing techniques and relatively little is known about the role and importance of the polymorphic residues as regards to the function of DP molecules. In the present study, polymerase chain reaction (PCR) primers were designed for identification of all the phenotypically different DPB1 alleles by PCR amplification with sequence-specific primers. Forty-eight standard genomic PCR reactions per sample were performed in order to achieve this resolution. Unique amplification patterns were obtained in 2983 of 3160 (94.4%) possible genotypes. The primers were combined so that only very rare genotypes gave rise to ambiguous patterns. Sixty-four Histocompatibility Workshop cell lines and 150 DNAs provided by the UCLA DNA exchange were investigated by the DPB1 primer set. All typing results were conclusive. Analysis of the distribution of DPB1 alleles was performed in 200 Caucasian samples, 100 African samples and 40 Oriental samples. The population study by the DPB1 PCR-SSP method showed a characteristic distribution of HLA-DPB1 alleles. Each ethnic group had one, or two, frequent DPB1 allele(s) and the frequency of homozygotes was high, suggesting that balancing selection does not appear to be affecting the evolution of the DPB1 locus.
Collapse
Affiliation(s)
- A Aldener-Cannavá
- Department of Biosciences at Novum, Karolinska Institutet, Huddinge and Division of Clinical Immunology, Karolinska Institutet at Huddinge University Hospital, Huddinge, Sweden.
| | | |
Collapse
|
50
|
Petersdorf EW, Gooley T, Malkki M, Anasetti C, Martin P, Woolfrey A, Smith A, Mickelson E, Hansen JA. The biological significance of HLA-DP gene variation in haematopoietic cell transplantation. Br J Haematol 2001; 112:988-94. [PMID: 11298597 DOI: 10.1046/j.1365-2141.2001.02655.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although it has been over 25 years since HLA-DP was mapped to the major histocompatibility complex (MHC), its biological functions remain ill-defined. We sought to test the hypothesis that HLA-DP functions in a manner similar to that of other class II genes by measuring the risk of clinically severe grades III-IV acute graft-vs.-host disease (GVHD) associated with recipient HLA-DP disparity after haematopoietic cell transplantation. HLA-DPB1 exon 2 was sequenced in 205 patients who underwent transplantation from HLA-A, -B, -C, -DRB1 and -DQB1 allele-matched unrelated donors. HLA-DPB1 mismatched recipients experienced a significantly increased risk of acute GVHD compared with HLA-DP-identical transplants. Patients who were mismatched for a single HLA-DPB1 allele had an odds ratio (OR) of 1.0 (0.5, 2.2; P = 0.99) and patients who were mismatched for two alleles had an OR of 2.2 (1.0, 4.9; P = 0.06) for developing acute GVHD. Compared with matched and single-allele mismatched transplants, patients who were mismatched for two DPB1 alleles had an OR of 2.2 (1.2, 4.1; P = 0.01). HLA-DP plays an important role in the alloimmune response. A threshold effect of multiple HLA-DP disparities is evident in determining the risk of acute GVHD after haematopoietic cell transplantation from unrelated donors.
Collapse
Affiliation(s)
- E W Petersdorf
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, D4-100, Seattle, WA 98109-1024, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|