1
|
Lee H, Lee H, Eum SH, Ko EJ, Min JW, Oh EJ, Yang CW, Chung BH. Impact of Low-Level Donor-Specific Anti-HLA Antibody on Posttransplant Clinical Outcomes in Kidney Transplant Recipients. Ann Lab Med 2023; 43:364-374. [PMID: 36843405 PMCID: PMC9989540 DOI: 10.3343/alm.2023.43.4.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/07/2022] [Accepted: 01/27/2023] [Indexed: 02/28/2023] Open
Abstract
Background The clinical significance of low-level donor-specific anti-HLA antibody (low-DSA) remains controversial. We investigated the impact of low-DSA on posttransplant clinical outcomes in kidney transplant (KT) recipients. Methods We retrospectively reviewed 1,027 KT recipients, namely, 629 living donor KT (LDKT) recipients and 398 deceased donor KT (DDKT) recipients, in Seoul St. Mary's Hospital (Seoul, Korea) between 2010 and 2018. Low-DSA was defined as a positive anti-HLA-DSA result in the Luminex single antigen assay (LABScreen single antigen HLA class I - combi and class II - group 1 kits; One Lambda, Canoga Park, CA, USA) but a negative result in a crossmatch test. We compared the incidence of biopsy-proven allograft rejection (BPAR), changes in allograft function, allograft survival, patient survival, and posttransplant infections between subgroups according to pretransplant low-DSA. Results The incidence of overall BPAR and T cell-mediated rejection did not differ between the subgroups. However, antibody-mediated rejection (ABMR) developed more frequently in patients with low-DSA than in those without low-DSA in the total cohort and the LDKT and DDKT subgroups. In multivariate analysis, low-DSA was identified as a risk factor for ABMR development. Its impact was more pronounced in DDKT (odds ratio [OR]: 9.60, 95% confidence interval [CI]: 1.79-51.56) than in LDKT (OR: 3.76, 95% CI: 0.99-14.26) recipients. There were no significant differences in other outcomes according to pretransplant low-DSA. Conclusions Pretransplant low-DSA has a significant impact on the development of ABMR, and more so in DDKT recipients than in LDKT recipients, but not on long-term outcomes.
Collapse
Affiliation(s)
- Haeun Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hanbi Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Hun Eum
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Eun Jeong Ko
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Transplant Research Center, Convergent Research Consortium for Immunologic Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Won Min
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Eun-Jee Oh
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Transplant Research Center, Convergent Research Consortium for Immunologic Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Transplant Research Center, Convergent Research Consortium for Immunologic Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
2
|
Rao PN, Deo DD, Gaur A, Baran DA, Zucker MJ, Kapoor S, Marchioni MA, Almendral J, Kandula P, Patel A. A new flow cytometry assay identifies recipient IgG subtype antibodies binding donor cells: increasing donor availability for highly sensitised patients. Clin Transl Immunology 2022; 11:e1415. [PMID: 36092480 PMCID: PMC9446897 DOI: 10.1002/cti2.1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/13/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives There are four immunoglobulin (IgG) subtypes that have varying complement‐activating ability: strong (IgG3 and IgG1) and weak (IgG2 and IgG4). The standard flow cytometric crossmatch (FCM) assay does not distinguish between the various subtypes of the IgG molecule. This study outlines the development and use of a novel cell‐based IgG subtype‐specific FCM assay that is able to detect the presence of and quantitate the IgG subtypes bound to donor cells. Methods A six‐colour lyophilised reagent was designed that specifically detects the four IgG subtypes, as well as distinguishes between T cells and B cells in the lymphocyte population. To test the efficacy of this reagent, a retrospective evaluation of a group of highly sensitised patients awaiting heart and kidney transplant was carried out, who, because of positive standard FCM results, had been deemed incompatible with numerous prior potential donors. Results Observations in this study demonstrate that the positive standard FCM results were mainly because of the presence of noncomplement‐activating IgG2 or IgG4 antibodies. The results were supported by the absence of C3d‐binding donor‐specific antibodies (DSA) and a negative complement‐dependent cytotoxicity crossmatch (CDC). Conclusion Preliminary data presented in this study demonstrate the reliability of the novel IgG subtype assay to detect the presence of pretransplant, complement‐activating antibodies bound to donor cells. The knowledge gained from the IgG subtype assay and the C3d‐binding specificities of DSAs provides improved identification of donor suitability in pretransplant patients, potentially increasing the number of transplants.
Collapse
Affiliation(s)
- Prakash N Rao
- Personalized Transplant Medicine Institute New Providence NJ USA
| | - Dayanand D Deo
- Personalized Transplant Medicine Institute New Providence NJ USA
| | | | | | | | | | | | | | | | - Anup Patel
- Robert Wood Johnson Barnabas Health Livingston NJ USA
| |
Collapse
|
3
|
Arrunátegui AM, Ramón DS, Viola LM, Olsen LG, Jaramillo A. Aspectos técnicos y clínicos de la prueba cruzada de histocompatibilidad en el trasplante de órganos sólidos. biomedica 2022; 42:391-413. [PMID: 35867930 PMCID: PMC9467682 DOI: 10.7705/biomedica.6255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Indexed: 11/21/2022]
Abstract
La presencia de anticuerpos dirigidos contra los antígenos leucocitarios humanos (Human Leukocyte Antigens, HLA) que se expresan en las células del donante, es uno de los factores de riesgo más importantes asociados con las complicaciones clínicas después del trasplante. La prueba cruzada es una de las pruebas de histocompatibilidad más eficaces para la detección de anticuerpos específicos contra el donante en los receptores de injertos. En los primeros métodos de la prueba cruzada, se utilizaba la citotoxicidad dependiente del complemento, que es útil para detectar dichos anticuerpos responsables del rechazo hiperagudo del injerto, pero carece de la sensibilidad adecuada. Por ello, se desarrollaron métodos de pruebas cruzadas más sensibles, entre ellas, la prueba cruzada por citometría de flujo que hoy se considera el método preferido. En este artículo se revisa la evolución de la prueba cruzada y los factores más importantes que deben tenerse en cuenta al realizarla y al interpretar los resultados de esta prueba fundamental para la supervivencia a largo plazo del injerto.
Collapse
|
4
|
Evans P, Lane A, Lambert C, Reynolds W, Wilson P, Harris K, Slapak M, Lee H, Smith J. Lack of correlation between IgG T-lymphocyte flow cytometric crossmatches with primary renal allograft outcome. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.609] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
5
|
Affiliation(s)
- Mats Alheim
- Department of Laboratory Medicine, Division of Clinical Immunology and Transfusion Medicine Karolinska University Hospital Stockholm Sweden
| |
Collapse
|
6
|
Brown NK, Meade JR, Wang J, Marino SR. Reanalysis of the role of pronase treatment of B cells in the flow cytometric crossmatch assay: Fc receptor is not the primary target. Hum Immunol 2017; 78:704-709. [PMID: 28987959 DOI: 10.1016/j.humimm.2017.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/30/2017] [Accepted: 10/04/2017] [Indexed: 11/19/2022]
Abstract
Pronase, a mixture of nonspecific bacterial proteases, is used to pretreat human lymphocytes to prevent false-positive B cell results in the flow cytometric crossmatch (FCXM) assay. The target of pronase has been reported to be B cell-expressed Fc receptors, which nonspecifically bind IgG. As pronase use in FCXM can induce other complications, including degradation of HLA leading to inappropriate FCXM results, and false-positive T cell results when testing serum from HIV-positive patients, we tested whether specifically blocking Fc receptor CD32 could replace pronase. Anti-CD32 mAb 6C4 was superior to pronase for blocking binding of aggregated IgG to B cells. However, 6C4 was unable to replace pronase in clinical FCXM, as it did not prevent false-positive B cell FCXM results, or enhance sensitivity of the assay. We conclude that the functional targets of pronase in the FCXM assay are poorly understood, and that B cell-expressed Fc receptor plays an insignificant role.
Collapse
Affiliation(s)
- Nicholas K Brown
- Department of Pathology, University of Chicago Medicine, Chicago, IL, United States.
| | - James R Meade
- Department of Pathology, University of Chicago Medicine, Chicago, IL, United States
| | - Jinguo Wang
- Department of Pathology, University of Chicago Medicine, Chicago, IL, United States
| | - Susana R Marino
- Department of Pathology, University of Chicago Medicine, Chicago, IL, United States.
| |
Collapse
|
7
|
South AM, Grimm PC. Transplant immuno-diagnostics: crossmatch and antigen detection. Pediatr Nephrol 2016; 31:897-905. [PMID: 26139577 DOI: 10.1007/s00467-015-3145-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/01/2015] [Accepted: 06/08/2015] [Indexed: 12/29/2022]
Abstract
Identifying and monitoring donor-directed anti-human leukocyte antigen antibodies are a rapidly evolving area of solid organ transplantation. Donor-specific antibodies dictate pre-transplant donor choice and donor-recipient matching and underlie much acute and chronic allograft rejection and loss. The evolution of available technology has driven this progress. Early, labor-intensive, whole-cell assays based on complement-dependent cytotoxicity suffered from poor sensitivity and specificity, technical challenges and lack of precision. Sequential improvement in assay performance included anti-human immunoglobulin-enhanced, complement-dependent cytotoxicity techniques followed by cell-based flow cytometry. However, variable specificity and sensitivity inherent in cell-based testing continued to limit flow cytometry. The introduction of solid-phase assays led to a second revolution in histocompatibility testing with the use of purified antigens bound to artificial surfaces rather than whole cells. These techniques augmented sensitivity and specificity to detect even low-titer antibodies to previously undetected antigens. Identification of complement-activating antibodies is being introduced, but current technology is in the developmental stage. While the detection of alloantibodies has improved dramatically, our comprehension of their importance remains imperfect. Variability in methodology and a lack of standardization limits the clinical application of these tests. In spite of the hurdles that remain, antibody-mediated rejection has become a key target to improve graft survival.
Collapse
|
8
|
Bub CB, Gonçalez AC, Barjas-Castro ML, Sousa LCDM, do Monte SJH, Castro V. The use of a potential novel tool in virtual crossmatching for platelet transfusion in platelet refractoriness. Vox Sang 2015; 110:70-8. [DOI: 10.1111/vox.12315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/17/2015] [Accepted: 06/22/2015] [Indexed: 12/01/2022]
Affiliation(s)
- C. B. Bub
- Hematology and Hemotherapy Center; University of Campinas - UNICAMP; Instituto Nacional de Ciência e Tecnologia do Sangue (INCTS); Campinas Brazil
| | - A. C. Gonçalez
- Hematology and Hemotherapy Center; University of Campinas - UNICAMP; Instituto Nacional de Ciência e Tecnologia do Sangue (INCTS); Campinas Brazil
| | - M. L. Barjas-Castro
- Hematology and Hemotherapy Center; University of Campinas - UNICAMP; Instituto Nacional de Ciência e Tecnologia do Sangue (INCTS); Campinas Brazil
| | - L. C. D. M. Sousa
- Immunogenetics and Molecular Biology Laboratory; Federal University of Piauí; Teresina Brazil
| | - S. J. H. do Monte
- Immunogenetics and Molecular Biology Laboratory; Federal University of Piauí; Teresina Brazil
| | - V. Castro
- Hematology and Hemotherapy Center; University of Campinas - UNICAMP; Instituto Nacional de Ciência e Tecnologia do Sangue (INCTS); Campinas Brazil
| |
Collapse
|
9
|
Kute VB, Vanikar AV, Gumber MR, Trivedi VB, Shah PR, Patel HV, Balwani MR, Modi PR, Trivedi HL. Kidney transplantation with positive complement-dependent lymphocytotoxicity crossmatch with negative flow crossmatching and Luminexx donor-specific antibodies. Ren Fail 2013; 35:1027-30. [PMID: 23829775 DOI: 10.3109/0886022x.2013.810539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
10
|
Alheim M, Paul PK, Hauzenberger DM, Wikström AC. Evaluation of a new flow cytometry crossmatch procedure for simultaneous detection of cytotoxicity and antibody binding. ACTA ACUST UNITED AC 2013; 82:125-30. [DOI: 10.1111/tan.12151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 05/08/2013] [Accepted: 05/22/2013] [Indexed: 11/29/2022]
Affiliation(s)
- M. Alheim
- Department of Laboratory Medicine, Division of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm; Sweden
| | - P. K. Paul
- Department of Laboratory Medicine, Division of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm; Sweden
| | - D.-M. Hauzenberger
- Department of Laboratory Medicine, Division of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm; Sweden
| | | |
Collapse
|
11
|
Tzvetanov I, Spaggiari M, Jeon H, Roca RG, Bhati C, Oberholzer J, Benedetti E. The role of splenectomy in the setting of refractory humoral rejection after kidney transplantation. Transplant Proc 2012; 44:1254-8. [PMID: 22663995 DOI: 10.1016/j.transproceed.2012.01.109] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 01/21/2012] [Indexed: 02/07/2023]
Abstract
Living donor kidney transplantation remains the best option for presensitized recipients to avoid excessive time on the waiting list. However, the possibility for a positive crossmatch with a potential living donor is high. A desensitization protocol may be required to avoid antibody-mediated rejection (AMR). Current protocols are not always effective to prevent AMR and in some cases fail to convert subjects to a negative crossmatch before transplantation. From March 2006 to January 2011, the 11 presensitized patients who displayed AMR after living donor kidney transplantation underwent splenectomy as a rescue procedure due to failure of standard rejection treatments. Splenectomy was considered to be effective in six recipients who normalized their renal function without the need for other immunomodulating therapy. Our analysis suggested that splenectomy can be successfully performed alone or in association with other treatments like bortezomib or rituximab to overcome severe AMR.
Collapse
Affiliation(s)
- I Tzvetanov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | | | | | | | | | | |
Collapse
|
12
|
AlMahri A, Holgersson J, Alheim M. Detection of complement-fixing and non-fixing antibodies specific for endothelial precursor cells and lymphocytes using flow cytometry. ACTA ACUST UNITED AC 2012; 80:404-15. [PMID: 22931381 DOI: 10.1111/j.1399-0039.2012.01954.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 06/21/2012] [Accepted: 07/30/2012] [Indexed: 11/27/2022]
Abstract
Donor human leukocyte antigen (HLA)-specific antibodies (Abs) with the ability to activate complement are associated with an increased risk of early Ab-mediated rejection (AMR) of kidney allografts. In recent years, also non-HLA Abs-binding endothelial cells have been shown to elicit early AMR. Donor-specific anti-endothelial cell Abs escape detection in the pre-transplant evaluation if only lymphocytes are used as target cells in crossmatch tests. We addressed whether endothelial precursor cells (EPCs) could be used for detection of complement-fixing as well as non-fixing Abs and if complement factor and immunoglobulin G (IgG) deposition on co-purified T and B cells correlated to the outcome of the T- and B-cell complement-dependent cytotoxicity assay. Deposition of complement factors C3c and C3d, but not C1q nor C4d, were detected on EPCs and lymphocytes upon incubation with HLA Ab-positive sera. There was a correlation between the amount of C3c deposition and IgG binding on EPCs (R(2) = 0.71, P = 0.0012) and T cells (R(2) = 0.74, P = 0.0006) but not for B cells (R(2) = 0.34, P = 0.059). The specificity and sensitivity for C3d deposition on endothelial precursor cell crossmatch (EPCXM) T cells vs the T complement-dependent cytotoxicity (CDC) assay were 69% and 72%, respectively. The EPCXM B-cell C3d assay had considerably lower sensitivity (39%) than the B CDC assay. Altogether, this novel assay based on the detection of complements factors on EPCs and lymphocytes by flow cytometry may widen the diagnostic repertoire and thereby improve the clinical management of patients undergoing kidney transplantation.
Collapse
Affiliation(s)
- A AlMahri
- Division of Clinical Immunology and Transfusion Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | | | | |
Collapse
|
13
|
Graff RJ, Lentine KL, Xiao H, Duffy B. The Role of the Crossmatch in Kidney Transplantation: Past, Present and Future. J Nephrol Ther 2012; Suppl 4:002. [PMID: 32879751 PMCID: PMC7462663 DOI: 10.4172/2161-0959.s4-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Immunogenetic characterization of the transplant recipient with crossmatch is used to minimize graft loss by detecting preformed antibodies. Use of increasingly sensitive tests including flow cytometry crossmatch (FCXM) has been accompanied by near elimination of hyperacute rejection. We reviewed associations of crossmatch results with kidney graft outcomes in contemporary practice, and provided updates of our past publications with more recent data in several instances. Recent United States registry data for transplants performed with a reported positive crossmatch demonstrate immediate graft loss rates of ≤1.3% or less in FCXM+ recipients, and ≤3.6% in complement-dependent cytotoxicity crossmatch positive (CDCXM+) recipients. One-year graft survival was reduced by ≤6.4% in FCXM+ versus FCXM- recipients, and by ≤11.5% in CDCXM+ versus CDCXM- recipients. Five-year graft survival was reduced by ≤10.2 % in FCXM+ versus FCXM- recipients, and by ≤8.7% in CDCXM+ versus CDCXM- recipients. A possible explanation for the markedly lower graft loss risk with crossmatch positive transplants in modern practice may be selection of recipients with low anti-HLA titers. Although a good correlation between virtual crossmatch and actual crossmatch has been demonstrated, the outcome significance of positive virtual/negative actual and negative virtual/positive actual crossmatches is not clearly established. Post-transplant demonstration of the persistence or appearance of donor-specific antibody is of value in prognostication, but utility for adjustment of therapy is uncertain. In summary, contemporary data suggest that, among selected transplants performed, the impact of a positive crossmatch may be relatively small compared to other accepted clinical factors. Further study is warranted work to determine, prospectively, under what circumstances crossmatch positive transplants can precede with safety.
Collapse
Affiliation(s)
- Ralph J. Graff
- Saint Louis University Medical Center Histocompatibility and Immunology Laboratory, St. Louis, MO
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
- Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, St. Louis, MO
| | - Krista L. Lentine
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Huiling Xiao
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Brian Duffy
- Saint Louis University Medical Center Histocompatibility and Immunology Laboratory, St. Louis, MO
- Barnes-Jewish Hospital HLA laboratory, St. Louis MO
| |
Collapse
|
14
|
|
15
|
Gandhi M, DeGoey S, Bundy K, Kremers W, Knauer R, Pereira N, Edwards B, Kushwaha S, Daly R. Effect of Pretransplant Human Leukocyte Antigen Antibodies Detected by Solid-Phase Assay on Heart Transplant Outcomes. Transplant Proc 2011; 43:3840-6. [DOI: 10.1016/j.transproceed.2011.08.077] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 08/30/2011] [Indexed: 11/26/2022]
|
16
|
Couzi L, Araujo C, Guidicelli G, Bachelet T, Moreau K, Morel D, Robert G, Wallerand H, Moreau JF, Taupin JL, Merville P. Interpretation of positive flow cytometric crossmatch in the era of the single-antigen bead assay. Transplantation 2011; 91:527-35. [PMID: 21192319 DOI: 10.1097/TP.0b013e31820794bb] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Prognosis of renal transplants with positive flow cytometric crossmatch (FCXM) remains controversial. METHODS We analyzed the outcome of these kidney transplant recipients by human leukocyte antigen (HLA) donor-specific antibodies (HLA-DSA) using single-antigen bead (SAB) assays in major histocompatibility complex classes I and II. We compared them with controls with a negative FCXM. RESULTS Forty-five patients consecutively transplanted with a positive FCXM had significantly more acute rejection episodes than the control patients (33.3% vs. 8.9%, P=0.002). Risk of acute rejection was increased with day 0 (D0) positive T-cell FCXM (odds ratio [OR]=9.04, P=0.002), D0 positive B-cell FCXM (OR=7.43, P=0.02), and D0 HLA-DSA identified by SAB assay (OR=6.5, P=0.03). The 21 patients with D0 positive FCXM and D0 HLA-DSA had more acute rejection (62%, P=0.0001) and a lower estimated glomerular filtration rate 1-year posttransplantation (P=0.0001), when compared with controls. Mainly anti-Cw and anti-DP HLA-DSA were found in patients displaying acute rejection. The remaining FCXM-positive patients displayed short-term outcomes similar to controls. The presence of HLA-DSA detected only by the SAB assay in the context of a negative FCXM crossmatch was not associated with increased risk of acute rejection. CONCLUSION Identification of HLA-DSA in D0 sera by the two sensitive techniques FCXM and SAB assay indicates which patients are at highest risk of subsequent acute allograft rejection and chronic allograft dysfunction.
Collapse
|
17
|
Abstract
For most solid organ and selected stem cell transplants, antibodies against mismatched HLA antigens can lead to early and late graft failure. In recognition of the clinical significance of these antibodies, HLA antibody identification is one of the most critical functions of histocompatibility laboratories. Early methods employed cumbersome and insensitive complement-dependent cytotoxicity assays with a visual read-out. A little over 20 years ago flow cytometry entered the realm of antibody detection with the introduction of the flow cytometric crossmatch. Cytometry's increased sensitivity and objectivity quickly earned it popularity as a preferred crossmatch method especially for sensitized recipients. Although a sensitive method, the flow crossmatch was criticized as being "too sensitive" as false positive reactions were a know drawback. In part, the shortcomings of the flow crossmatch were due to the lack of corresponding sensitive and specific HLA antibody screening assays. However, in the mid 1990s, solid phase assays, capable of utilizing standard flow cytometers, were developed. These assays used microparticles coated with purified HLA molecules. Hence, the era of solid-phase, microparticle technology for HLA antibody detection was born permitting the sensitive and specific detection of HLA antibody. It was now possible to provide better correlation between HLA antibody detection and the flow cytometric crossmatch. This flow-based technology was soon followed by adaptation to the Luminex platform permitting a mutltiplexed approach for the identification and characterization of HLA antibodies. It is hoped that these technologies will ultimately lead to the identification of parameters that best correlate with and/or predict transplant outcomes.
Collapse
|
18
|
Morris GP, Phelan DL, Jendrisak MD, Mohanakumar T. Virtual crossmatch by identification of donor-specific anti-human leukocyte antigen antibodies by solid-phase immunoassay: a 30-month analysis in living donor kidney transplantation. Hum Immunol 2010; 71:268-73. [PMID: 20074605 DOI: 10.1016/j.humimm.2010.01.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 12/18/2009] [Accepted: 01/06/2010] [Indexed: 01/08/2023]
Abstract
Selection of donors for kidney transplantation depends on accurate prediction of risk factors for immunologic rejection. Historically, cytotoxicity crossmatch (CXM) examining lysis of donor cells by preformed anti-human leukocyte antigen (HLA) antibodies (Abs) has been considered the best predictor of immunologic rejection. However, there is much interest in defining anti-HLA Ab specificity in recipient sera by immunoassay to predict crossmatch results and aid in donor selection. Current immunoassays for anti-HLA Abs are highly sensitive, though correlation between Abs detected by immunoassay and their functional relevance in CXM and subsequent transplantation is not well defined. In this study, we retrospectively examined the predictive value of detection of donor-specific anti-HLA Abs (DSA) by Luminex Single Antigen assay from 149 consecutive living donor kidney transplant recipients. We demonstrate that detection of DSA by immunoassay accurately predicted negative crossmatch and graft survival. However, this approach had limited sensitivity for predicting positive crossmatch, attributable to either limited typing of donor HLA-DQ and -DP alleles or due to non-HLA Abs. False-positive prediction of CXM correlated with detection of "weak" Abs with low mean fluorescence intensity (MFI < 2000). Furthermore, we found that a ratio of the MFI of the DSA bead to the MFI of the positive control bead was a better method for identifying weak DSA that did not result in CXM-positive reactions. Interestingly, patients with weak DSA and negative CXM had equivalent graft survival over an 18 month follow-up period, suggesting that weak DSA may not preclude transplantation.
Collapse
|
19
|
Matsuhashi M, Tsuno NH, Kawabata M, Yokoyama T, Tazaki Y, Takashima T, Oda H, Kuroda Y, Nagayoshi Y, Morita S, Shibata Y, Santoso S, Takahashi K. The first case of alloantibody against human platelet antigen-15b in Japan: possible alloimmunization by a hydatidiform mole. Transfusion 2009; 50:1126-30. [PMID: 20030792 DOI: 10.1111/j.1537-2995.2009.02537.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The involvement of the human platelet antigen (HPA)-15 system in neonatal alloimmune thrombocytopenia (NAIT) has been reported in various populations, but not in the Japanese population. In Japan, the mixed passive hemagglutination assay (MPHA) is used for detection of HPA alloantibodies. However, most of the reported cases of HPA-15 incompatibility are based on the monoclonal antibody immobilization of platelet antigen (MAIPA) assay or immunoprecipitation; thus there is a possibility that HPA-15 alloantibodies are not efficiently detected by the MPHA, and currently, the causative antibody is not detectable in approximately half of the suspected NAIT cases in Japan. STUDY DESIGN AND METHODS We examined the sera of mothers from NAIT cases, previously with undetected HPA antibodies by MPHA, using the MAIPA technique. Sera from 90 mothers of suspected NAIT were tested by MAIPA for the presence of anti-HPA-15 alloantibodies. RESULTS Anti-HPA-15b was detected in one case. This case was a mother in the first pregnancy diagnosed as hydatid mole-coexisting fetus, and the baby was born with suspected NAIT. The familial analysis revealed compatibility of HPA-15 genotype between the mother and the baby (both HPA-15a/a), but incompatibility with the paternal one (HPA-15a/b). The hydatid mole's tissue was genotyped as HPA-15b positive. Besides anti-HPA-15b, maternal sera contain strong HLA Class I antibody CONCLUSIONS Here we reported the first case of anti-HPA-15 in Japan. Alloimmunization against the hydatid mole seems to be responsible for the production of HPA-15b alloantibody. This antibody, however, did not apparently involve in the development of NAIT of the newborn, the coexisting anti-HLA Class I being the possible cause.
Collapse
Affiliation(s)
- Mika Matsuhashi
- Department of Transfusion Medicine, The University of Tokyo, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Stehlik J, Islam N, Hurst D, Kfoury AG, Movsesian MA, Fuller A, Delgado JC, Hammond MEH, Gilbert EM, Renlund DG, Bader F, Fisher PW, Bull DA, Singhal AK, Eckels DD. Utility of virtual crossmatch in sensitized patients awaiting heart transplantation. J Heart Lung Transplant 2009; 28:1129-34. [PMID: 19782589 DOI: 10.1016/j.healun.2009.05.031] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 05/23/2009] [Accepted: 05/24/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Organ transplant candidates with serum antibodies directed against human leukocyte antigens (HLA) face longer waiting times and higher mortality while awaiting transplantation. This study examined the accuracy of virtual crossmatch, in which recipient HLA-specific antibodies, identified by solid-phase assays, are compared to the prospective donor HLA-type in heart transplantation. METHODS We examined the accuracy of virtual crossmatch in predicting immune compatibility of donors and recipients in heart transplantation and clinical outcomes in immunologically sensitized heart transplant recipients in whom virtual crossmatch was used in allograft allocation. RESULTS Based on analysis of 257 T-cell antihuman immunoglobulin complement-dependent cytotoxic (AHG-CDC) crossmatch tests, the positive predictive value of virtual crossmatch (the likelihood of an incompatible virtual crossmatch resulting in an incompatible T-cell CDC-AHG crossmatch) was 79%, and the negative predictive value of virtual crossmatch (the likelihood of a compatible virtual crossmatch resulting in a compatible T-cell CDC-AHG crossmatch) was 92%. When used in a cohort of 28 sensitized patients awaiting heart transplantation, 14 received allografts based on a compatible virtual crossmatch alone from donors in geographically distant locations. Compared with the other 14 sensitized patients who underwent transplant after a compatible prospective serologic crossmatch, the rejection rates and survival were similar. CONCLUSION Our findings are evidence of the accuracy of virtual crossmatch and its utility in augmenting the opportunities for transplantation of sensitized patients.
Collapse
Affiliation(s)
- Josef Stehlik
- U.T.A.H. Cardiac Transplant Program, University of Utah Hospital, and VA Salt Lake City Health Care System-Cardiology Section, 500 Foothill Blvd., Salt Lake City, UT 84148, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Phelan D, Mohanakumar T, Ramachandran S, Jendrisak MD. Living donor renal transplantation in the presence of donor-specific human leukocyte antigen antibody detected by solid-phase assay. Hum Immunol 2009; 70:584-8. [DOI: 10.1016/j.humimm.2009.05.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 04/23/2009] [Accepted: 05/20/2009] [Indexed: 02/04/2023]
|
22
|
Gebel HM, Moussa O, Eckels DD, Bray RA. Donor-reactive HLA antibodies in renal allograft recipients: Considerations, complications, and conundrums. Hum Immunol 2009; 70:610-7. [DOI: 10.1016/j.humimm.2009.04.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Accepted: 04/09/2009] [Indexed: 11/30/2022]
|
23
|
|
24
|
|
25
|
|
26
|
Delgado JC, Eckels DD. Positive B-cell only flow cytometric crossmatch: Implications for renal transplantation. Exp Mol Pathol 2008; 85:59-63. [DOI: 10.1016/j.yexmp.2008.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 03/02/2008] [Indexed: 11/25/2022]
|
27
|
|
28
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
29
|
|
30
|
Abstract
Preformed donor-specific HLA-antibodies antibodies (DSA) are a major risk for early antibody-mediated rejection (AMR). This prospective study evaluated the accuracy of pretransplant risk assessment using virtual crossmatching (virtualXM) (i.e. comparing HLA-typing of the donor with the recipient's HLA-antibody specificities determined by flow-beads). Sixty-five consecutive patients were stratified according to virtualXM results: patients without DSA (n= 56) were considered low risk and received standard immunosuppression; patients with DSA (n= 9) were considered high risk and received additional induction with anti-T-lymphocyte-globulin (ATG) and intravenous immunoglobulins. Despite induction therapy 4 of 9 patients with DSA (44%) had clinical/subclinical AMR, whereas only 2 of 56 patients without DSA (4%) (p = 0.002). Notably, one of these two patients had early AMR likely induced by non-HLA-antibodies; the other had subclinical AMR at month 6 consistent with de novo DSA. The results of virtualXM and retrospectively obtained flow-cytometric crossmatches (FCXM) (n= 59) were concordant in 51 patients (86%), four patients (7%) were virtualXM-/FCXM+ and none had AMR, four patients (7%) were virtualXM+/FCXM- and one had AMR. VirtualXM can accurately define absence or presence of DSA and may become an invaluable tool for organ allocation and pretransplant risk assessment. However, further studies need to address whether all HLA-antibodies detected by flow-beads are clinically relevant.
Collapse
Affiliation(s)
- D Bielmann
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
The human major histocompatibility complex HLA is located on the short arm of chromosome 6. It is known to be the most polymorphic genetic system in humans. The biological role of the HLA class I and class II molecules is to present processed peptide antigens. The HLA system is clinically important as transplantation antigens. Molecular HLA allele typing is routinely performed to provide HLA class I and class II allele matching in unrelated donor hematopoietic stem cell transplantation. Prospective lymphocyte crossmatching is critical in solid organ transplantation to prevent allograft rejection. HLA alloimmunization causes various problems in transfusion therapy. The HLA system is associated with certain diseases, but its underlying mechanisms are not yet fully explained.
Collapse
Affiliation(s)
- Sung Yoon Choo
- Department of Pathology, Mount Sinai School of Medicine, New York, NY 10029, USA.
| |
Collapse
|
32
|
Nakazawa Y, Saito S, Hasegawa Y, Yanagisawa R, Sakashita K, Kamijo T, Miyazaki T, Sato S, Ikeda H, Ikebuchi K, Koike K. A possible role for the production of multiple HLA antibodies in fatal platelet transfusion refractoriness after peripheral blood progenitor cell transplantation from the mother in a patient with relapsed leukemia. Transfusion 2007; 47:326-34. [PMID: 17302780 DOI: 10.1111/j.1537-2995.2007.01109.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There has been controversy over whether HLA alloimmunization is a risk factor for platelet (PLT) transfusion refractoriness (PTR) in hematopoietic peripheral blood progenitor cell transplantation (HPBPCT). STUDY DESIGN AND METHODS Reported here is a boy with relapsed leukemia who developed fatal PTR after a peripheral blood progenitor cell transplantation (PBPCT) as a second HPBPCT from his mother. To elucidate the cause of PTR, a single-antigen assay (FlowPRA, One Lambda), a magnetic particles mixed passive hemagglutination test, and anti-human immunoglobulin-lymphocyte cytotoxicity test were performed on serum samples of the patient and his mother. RESULTS Although HLA Class I antibodies were absent in his serum sample before HPBPCT, the serum sample after the first bone marrow transplantation (BMT) reacted weakly with beads coated with multiple HLA Class I molecules. After PBPCT, the positive reaction markedly increased. Although HLA-B44 antibody emerged transiently after BMT, the apparent generation of antibodies against HLA-A2 and -A24 as well as HLA-B44 occurred after PBPCT. The continuous appearance of HLA Class I antibodies coincided with the duration of marked PTR after PBPCT. The patient, however, had no antibodies against PLT-specific glycoproteins. Unidentified HLA Class I-reactive antibodies were detected in maternal serum sample. CONCLUSION Although the patient appeared to be immunized to allogeneic HLA Class I molecules after BMT, profound HLA alloimmunization might have occurred after PBPCT in this case. It is possible that the administration of large numbers of immunocompetent cells sensitive to alloantigens at PBPCT causes the aberrant and persistent production of the HLA Class I antibodies.
Collapse
Affiliation(s)
- Yozo Nakazawa
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
New technologies have resulted in the ability to identify the presence of IgG human leukocyte antigen (HLA) or non-HLA antibodies in the sera of potential solid organ transplant recipients. Knowledge of the presence of these antibodies, their antigen specificities, and strength (titer) is crucial to understanding a patient's state of immunologic sensitization and reactivity. Finally, these data, when correlated with sensitive crossmatch results, allow clinicians to make more knowledgeable clinical decisions when paring donors and recipients for transplant.
Collapse
Affiliation(s)
- Ronald H Kerman
- The University of Texas Medical School, Houston, TX 77030, USA.
| |
Collapse
|
34
|
|
35
|
McLaughlin K, Manns B, Nickerson P. The Routine Use of High-Resolution Immunological Screening of Recipients of Primary Deceased Donor Kidney Allografts Is Cost-Effective. Transplantation 2006; 81:1278-84. [PMID: 16699455 DOI: 10.1097/01.tp.0000205797.05544.e5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The economic and health benefits of kidney transplantation are dependent on the length of allograft survival. High-resolution immunological screening can identify recipients at increased risk of early graft loss caused by acute rejection, but the use of these tests increases screening costs before transplantation. The objective of this study was to evaluate the cost-effectiveness of routine use of high-resolution flow-cytometry cross-matching and solid-phase screening for all recipients of primary deceased donor kidney transplants. METHODS A Markov model was constructed to evaluate costs and effects of two different clinical strategies on a simulated cohort of 1,000 transplant recipients: serological screening (SS) only and flow screening (FS) only. Outcomes measures were total cost of patient care over 25 years, life expectancy, quality-adjusted life expectancy, and transplant life expectancy. RESULTS In the base-case analysis, FS was associated with an average gain of 0.08 life years, 0.25 transplant life years, and 0.08 quality-adjusted life years per patient. SS was associated with a higher cost of CND$6,397 per patient, mostly because of increased use of dialysis in patients who suffered early graft loss under the SS strategy. The results were robust to uncertainty in the majority of variables, and a strategy using FS was cost-effective except under the unlikely scenario where the false-negative rate for SS was <or=2% or the early graft loss rate for flow-positive recipients was <or=7% (compared with 5% for flow-negative recipients). CONCLUSIONS Routine use of FS in recipients of first-deceased donor kidney transplants is cost-effective.
Collapse
Affiliation(s)
- Kevin McLaughlin
- Division of Nephrology, University of Calgary, Calgary, Alberta, Canada.
| | | | | |
Collapse
|
36
|
Matsuyama N, Kojima Y, Hirayama F, Yasui K, Taniue A, Fukumori Y, Yoshimura K, Tabata N, Sakata N, Tani Y, Shibata H. Simultaneous five cell-lineage flow cytometric analysis system for detection of leucocyte antibodies. Transfus Med 2006; 16:111-8. [PMID: 16623917 DOI: 10.1111/j.1365-3148.2006.00642.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although flow cytometric (FCM) analysis is one of the most widely used approaches to screen the presence of leucocyte antibodies, it has several drawbacks. First, neutrophils and, especially, monocytes exhibit high background reactivity. Second, to determine antibody specificity, it is often necessary to examine not only neutrophils and monocytes but also other lineage cells including T cells, B cells and platelets. Therefore, we attempted to establish an FCM analysis system in which four lineages of leucocytes and platelets are simultaneously tested with low background. FCM analysis was performed using ethylene diamine tetraacetic acid-anticoagulated whole blood as cell sample without any cell preparation. Discrimination of five cell lineages was carried out based on the differences in forward vs. side scatter distribution and in the expression of CD4, CD20 and CD14. When anti-HNA (human neutrophil antigen) 1b antiserum was applied to HNA 1b-positive blood samples, only neutrophils were unambiguously positive. When anti-Naka (anti-CD36) antiserum was applied, only platelets and monocytes were positive. The background reactivity of neutrophils and monocytes was low enough. When anti-human leucocyte antigen (HLA) class II antiserum was tested, only B-lymphocytes and monocytes were positive. When anti-HLA class I antiserum was tested, all the five-lineage cells were positive.
Collapse
Affiliation(s)
- N Matsuyama
- Japanese Red Cross Osaka Blood Center, Kinki University School of Medicine, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
New technological advances in the field of histocompatibility have provided an approach to systematically address the specificity of positive lymphocyte crossmatches. These approaches can now confirm whether a positive crossmatch is (or is not) due to class I and/or class II antibodies directed against donor HLA antigens. The information gained from the application of these sensitive and specific technologies can be used to predict crossmatch results for highly sensitized patients. In summary, these emerging technologies have provided the tools to reliably determine the clinical relevance of a positive lymphocyte crossmatch.
Collapse
Affiliation(s)
- Robert A Bray
- Department of Pathology, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA
| | | | | | | |
Collapse
|
38
|
Abstract
An increasing number of individuals with end-stage renal disease have become sensitized to human leukocyte antigens (HLA). Sensitization can have a profound impact on the likelihood of obtaining a requisite negative crossmatch (-XM) with a potential donor. Technologic breakthroughs in our ability to diagnose antibody-mediated rejection (AMR) and monitor anti-HLA antibodies has set the stage for a renascence in the understanding and treatment of individuals who harbor donor-specific antibody (DSA). Promising early results from single institutions that have developed preconditioning protocols allowing successful transplantation of XM (+) patients have encouraged other centers to adopt these protocols. Sensitized patients represent a great challenge for the clinician and there is much that remains unknown about the assessment and treatment of these patients. We have successfully preconditioned and transplanted more than 80 patients over a 5-yr period. As our understanding of these patients has increased, we have progressed from a 'one size fits all' approach to therapy to more rational, individualized treatment plans that take into account the varying immunologic risk that each patient possesses. In this article we have summarized our evolving experience with the assessment, treatment, transplantation, and monitoring of patients who undergo preconditioning for a (+) XM with a live donor.
Collapse
Affiliation(s)
- Robert A Montgomery
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | | |
Collapse
|
39
|
Bray RA, Harris SB, Josephson CD, Hillyer CD, Gebel HM. Unappreciated risk factors for transplant patients: HLA antibodies in blood components. Hum Immunol 2004; 65:240-4. [PMID: 15041162 DOI: 10.1016/j.humimm.2003.12.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2003] [Accepted: 12/22/2003] [Indexed: 11/21/2022]
Abstract
One of the more aggressive approaches in renal transplantation is the use of plasmapheresis (PP) and intravenous immunoglobulin to eliminate donor-directed human leukocyte antigen (HLA) alloantibodies. A potential complication of a PP protocol is iatrogenic hypocoagulability resulting from the removal of coagulation factors. To prevent bleeding, hypocoagulable patients may require transfusions with fresh frozen plasma (FFP) and/or cryoprecipitate (Cryo). Although HLA alloantibodies in these components have been linked to complications, such as transfusion-related acute lung injury (TRALI), whether they cause complications following transfusion into allograft recipients is unknown. The incidence of complications would be dependent, in part, upon the frequency of HLA alloantibodies in the various blood components. In this study, segments from 77 units of FFP, 66 units of Cryo, 106 units of packed red blood cells (RBCs), and 59 units of apheresis platelets (Plts) were tested for antibodies to HLA class I and class II antigens using FlowPRA, an HLA antigen-specific flow cytometric assay. On average, 22% of blood components tested contained HLA alloantibodies, tenfold greater than previously reported. This unappreciated frequency of HLA alloantibodies in blood components may pose a risk to transplant patients requiring transfusions by promoting allograft dysfunction or loss.
Collapse
Affiliation(s)
- Robert A Bray
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA 30322, United States
| | | | | | | | | |
Collapse
|
40
|
Noji H, Shichishima T, Ogawa K, Shikama Y, Ohto H, Maruyama Y. Transfusion-related acute lung injury following allogeneic bone marrow transplantation in a patient with acute lymphoblastic leukemia. Intern Med 2004; 43:1068-72. [PMID: 15609705 DOI: 10.2169/internalmedicine.43.1068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Transfusion-related acute lung injury (TRALI) is a clinical syndrome characterized by bilateral pulmonary edema in association with transfusions. We encountered a 23-year-old woman with acute lymphoblastic leukemia, in whom TRALI without anti-human leukocyte antigen class I and anti-granulocyte antibodies developed following allogeneic bone marrow transplantation. TRALI improved mainly in association with treatment of saline and ventilation support after several days, but graft-versus-host disease and thrombotic microangiopathy developed, resulting in death due to multiple organ failure. This case indicates that TRALI can also occur following allogeneic bone marrow transplantation.
Collapse
Affiliation(s)
- Hideyoshi Noji
- First Department of Internal Medicine, Fukushima Medical University, Fukushima
| | | | | | | | | | | |
Collapse
|
41
|
Rodriguez DS, Jankowska-Gan E, Haynes LD, Leverson G, Munoz A, Heisey D, Sollinger HW, Burlingham WJ. Immune regulation and graft survival in kidney transplant recipients are both enhanced by human leukocyte antigen matching. Am J Transplant 2004; 4:537-43. [PMID: 15023145 DOI: 10.1111/j.1600-6143.2004.00385.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We hypothesized that donor/recipient sharing of the human leukocyte antigen (HLA) involved in allopeptide presentation to the T regulatory cell increases the incidence of immune regulation, thus contributing to long-term graft survival. Peripheral blood mononuclear cells (PBMC) were obtained from 40 living related donor (LRD) and 31 cadaver renal transplant recipients. The trans vivo delayed type hypersensitivity (DTH) assay was used to assign patients to regulator, nonregulator, and sensitized categories. In a large cohort (n=1934 patients), primary graft survival and rejection episodes were analyzed using a log rank test for comparison with the DTH results. The highest incidence of regulated anti-donor DTH was observed in the LRD HLA-identical group (6/6; 100%) followed by the LRD HLA 1 haplotype matched group (18/27; 67%). Within the cadaver population, two DR-matched recipients had a higher frequency of regulated anti-donor DTH (6/11; 55%) than 1 & 0 DR-matched recipients (3/18; 17%). In a multivariate model, matching for HLA-DR alone, or for DR plus DQ was significantly (p=0.045, p=0.041) correlated with DTH regulation. The better HLA-matched groups showed the highest incidence of DTH regulation and, in a larger retrospective analysis, displayed better graft survival and freedom from acute rejection (p<0.0001). HLA matching, and HLA-DR matching in particular, correlates with the incidence of immune regulation after kidney transplantation.
Collapse
|
42
|
Gebel HM, Bray RA, Nickerson P. Pre-transplant assessment of donor-reactive, HLA-specific antibodies in renal transplantation: contraindication vs. risk. Am J Transplant 2003; 3:1488-500. [PMID: 14629279 DOI: 10.1046/j.1600-6135.2003.00273.x] [Citation(s) in RCA: 265] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Howard M Gebel
- Department of Pathology, Emory University Hospital, Atlanta, GA, USA.
| | | | | |
Collapse
|
43
|
de Sousa G. Update on leucodepletion, HLA and platelet serology at Lisbon Regional Blood Centre. Transfus Apher Sci 2003; 29:5-10. [PMID: 12877885 DOI: 10.1016/s1473-0502(03)00092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The characteristic performance of some leucodepletion processes at the Lisbon Regional Blood Centre is presented. The current position on HLA and platelet serology is briefly described.
Collapse
Affiliation(s)
- Gracinda de Sousa
- Centro Regional de Sangue de Lisboa, IPS, Av. do Brasil, 53 Pav. 17, 1749-005, Lisboa, Portugal.
| |
Collapse
|
44
|
Saito S, Ota M, Komatsu Y, Ota S, Aoki S, Koike K, Tokunaga I, Tsuno T, Tsuruta G, Kubo T, Fukushima H. Serologic analysis of three cases of neonatal alloimmune thrombocytopenia associated with HLA antibodies. Transfusion 2003; 43:908-17. [PMID: 12823751 DOI: 10.1046/j.1537-2995.2003.00429.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Neonatal alloimmune thrombocytopenia (NAIT) is caused when maternal alloantibodies react with paternally inherited antigens present on the fetal PLTs, a reaction mainly due to antibodies against human PLT antigens. Cases in which NAIT has been caused by HLA antibodies are relatively rare. In this study, three cases of NAIT associated with HLA antibodies that occurred in a 1-year period are reported. STUDY DESIGN AND METHODS The presence of HLA antibodies in these three NAIT case studies was elucidated by examining reactions of the neonatal and maternal sera with lymphocytes, PLTs, and beads from an HLA antibody screening test (FlowPRA, One Lambda Inc.). Absorption and elution tests with paternal cells were also conducted. In addition, the influence of titer and specificity of HLA antibodies on NAIT was analyzed in light of 24 other documented cases in Japan. RESULTS In the three case studies presented herein, antibodies against human PLT antigens were found in neither the maternal nor neonatal sera, while specific HLA antibodies were identified in both sera. Absorption of maternal serum with paternal PLTs eliminated the reactivity against paternal PLTs and lymphocytes. CONCLUSION Transplacental passage of maternal HLA antibodies was observed in the three neonates cited in the present study.
Collapse
Affiliation(s)
- Satoshi Saito
- Department of Legal Medicine, Shinshu University School of Medicine, Matumoto, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Papassavas AC, Stavropoulos-Giokas C, Boletis J, Ioannou S, Iniotaki-Theodoraki A, Kostakis A. Definition of permissible and immunogenic HLA antigens based on epitope analysis of the HLA specific antibodies produced in sensitized patients. Eur J Immunogenet 2002; 29:401-7. [PMID: 12358849 DOI: 10.1046/j.1365-2370.2002.00341.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The goal of this study was to develop an accurate protocol whereby detection of acceptable HLA-A and -B mismatches is based on epitope analysis of HLA class I specific antibodies detected in the serum of highly sensitized patients awaiting a kidney retransplant. A total of 400 serum samples from 44 highly sensitized patients with panel reactive antibodies (PRA) of > or = 60% were collected during a 3-year follow-up period. All patients had been sensitized from a previous graft. In order to define the specificities of the HLA class I specific antibodies, two techniques were used in parallel: the antihuman globulin augmented complement-dependent cytotoxicity (CDC) technique and an enzyme-linked immunoabsorbent assay (ELISA) technique. Epitope identification was based on class I HLA antigen sequencing, where the unique epitope configuration on one HLA antigen represented the private epitope of the specific HLA antigen, and epitopes shared by more than one HLA antigen represented public determinants. The epitope prediction for the immunogenic HLA epitopes was based on an MHC database. For each highly sensitized patient, antibody specificities against actual and 'at risk' epitopes were defined. Following epitope analysis, all HLA antigens that did not express the actual and/or 'at risk' immunogenic epitopes were considered as acceptable mismatches of epitope analysis. The cytotoxicity of highly sensitized patients was determined using two different panels of selected, separated T lymphocytes. HLA class I specific IgG antibodies against 69 actual and 86 'at risk' epitopes were detected. In all patients, a large number of acceptable mismatches were defined. These included a large number of HLA antigens, corresponding to both HLA-A and -B loci. Our study introduces an accurate protocol for the detection of acceptable mismatches in highly sensitized patients. According to this protocol, the detailed description of immunogenic HLA specific epitope targets, against which HLA class I specific antibodies are directed, is a useful tool for the detection of acceptable mismatches in highly sensitized patients. This may lead to reduced production of HLA class I specific antibodies and, consequently, improved graft survival.
Collapse
Affiliation(s)
- A C Papassavas
- Department of Immunology and National Tissue Typing Center, General Hospital Georgios Gennimatas, Athens, Greece.
| | | | | | | | | | | |
Collapse
|
46
|
Affiliation(s)
- V Dubois
- Laboratoire d'Histocompatibilité, Etablissement Français du Sang Rhône Alpes Site de Lyon, Lyon, France
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
This report describes an algorithm for identifying acceptable HLA antigens for highly alloimmunized patients without the need for extensive serum screening. This algorithm is based on the concept that immunogenic epitopes are represented by amino acid triplets on exposed parts of protein sequences of human leukocyte antigen chains (HLA-A, HLA-B, and HLA-C) accessible to alloantibodies. A computer program (HLAMatchmaker) has been developed to determine class I HLA compatibility at the molecular level. It makes intralocus and interlocus comparisons of polymorphic triplets in sequence positions to determine the spectrum of non-shared triplets on donor HLA antigens. In most cases is it possible to identify certain mismatched HLA antigens that share all their polymorphic triplets with the patient's HLA antigens and could therefore, be considered fully compatible. HLAMatchmaker permits also the identification of additional mismatches that are acceptable as determined from the triplet information on HLA-typed panel cells that do not react with patient's serum.HLAMatchmaker provides an assessment of donor-recipient HLA compatibility at the structural level and this algorithm is different from conventional methods based on the mere counting of numbers of mismatched HLA antigens or CREGs. This donor selection strategy is suitable especially for allosensitized patients in need of a compatible transplant or platelet transfusion.
Collapse
Affiliation(s)
- René J Duquesnoy
- CLSI Tissue Typing Laboratory, Department of Pathology, Division of Transplantation Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA, USA.
| |
Collapse
|
48
|
Abstract
The predictive power of a positive B-cell crossmatch remains controversial due to the presence of cofactors, such as sensitization and human leukocyte antigen (HLA) mismatch levels. UNOS OPTN/Scientific Registry data were analyzed on 9031 cadaveric kidney graft recipients who were B-cell crossmatched during 1994 and 1995 for graft outcome. This 2-year time period was chosen so that most US transplant recipients in this study would have had a similar regimen of immunosuppression consisting of prednisone, Sandimmune, and azathioprine The two patient groups that were analyzed were B-pos (n = 336) and B-neg (n = 8,695). All T-cell crossmatches were negative. Data analyzed included donor-recipient demographics, sensitization levels, B-cell crossmatch techniques, histocompatibility mismatching, graft rejection incidence, early graft loss, cause of graft failure, and statistical analyses (univariate and multivariate) in primary and repeat graft recipients. Significant factors in both crossmatch groups included pretransplant transfusions, peak and most recent class I PRA levels, a previous kidney graft, histocompatibility mismatching at HLA-A plus -B, urine in first 24 h, and rejection incidence between discharge and 6 months post-transplantation. Class II antibody specificities and panel reactive antibody (PRA) levels were not available from the UNOS database. Fifty-seven percent of 15,896 (1994-1995) transplant recipients (n 9031) were B-cell crossmatched, and 336 of 9031 recipients (3.7%) were transplanted with a B-pos crossmatch. Sixteen percent of B-pos recipients experienced early graft loss (< 6 months) compared with 11% of B-neg recipients (p < 0.001). Both primary and repeat grafts with B-pos crossmatches experienced an increase in rejection incidence (p = 0.023) and early graft loss (p < 0.001). In the sensitized (PRA > 10%) recipient subset (n = 2,789), both primary (n = 93) and regraft (n = 52) recipients with B-pos crossmatches had a higher incidence of early graft loss at 3 months, p < 0.001 and p = 0.016, respectively. HLA-DR mismatch levels in both patient groups were not different (p = 0.109). There was a 68% increase in the odds of 3-month graft loss in B-pos versus B-neg recipients (multivariate logistic regression analysis p = 0.054, 95% confidence interval 0.99-2.85). In conclusion, a B-pos crossmatch in primary and regraft recipients, including a sensitized subset, is predictive of inferior kidney graft outcome.
Collapse
Affiliation(s)
- Richard J Mahoney
- NorDx Immunogenetics Laboratory, Maine Medical Center, Brighton Campus, Portland, ME 04102-2374, USA
| | | | | |
Collapse
|
49
|
Saito S, Ota S, Seshimo H, Yamazaki Y, Nomura S, Ito T, Miki J, Ota M, Fukushima H, Maeda H. Platelet transfusion refractoriness caused by a mismatch in HLA-C antigens. Transfusion 2002; 42:302-8. [PMID: 11961234 DOI: 10.1046/j.1537-2995.2002.00051.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND HLA-C antigens have been thought to be of little significance in determining the efficacy of platelet transfusions. However, six alloimmunized patients were encountered who were refractory to platelet transfusions because of anti-HLA-Cw3, -Cw3, -Cw7, or -Cw8. STUDY DESIGN AND METHODS Between 1995 and the present, 88 patients with hematologic malignancies became refractory to random-donor platelet transfusions due to HLA antibodies. HLA-A- and HLA-B-compatible platelet transfusions were successful in boosting platelet levels with 82 of the patients. This study concerns the remaining six HLA-immunized patients who were refractory to HLA-A- and HLA-B-compatible platelet transfusions. The response to the platelet transfusions was assessed by calculating both 1- and 24-hour posttransfusion CCIs for each transfusion. RESULTS The average CCI(1 hour) and CCI(24 hours) in all patients were 20.0 and 12.8 for HLA-A-, HLA-B-, and HLA-C-compatible transfusions and were 1.4 and 1.2 for HLA-A- and HLA-B-compatible but HLA-C-incompatible transfusions, respectively (p < 0.001). CONCLUSION These findings clearly indicate that matching of the HLA-C antigens is also required in some alloimmunized patients to obtain the effectiveness of platelet transfusions.
Collapse
Affiliation(s)
- Satoshi Saito
- Tissue Typing Laboratory, Nagano Red Cross Blood Center, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Ayed K, Sassi F, Ben Abdallah T. Crossmatch in renal transplantation using a sensitive antiglobulin microlymphocytotoxicity test. Transplant Proc 2001; 33:2848-9. [PMID: 11498184 DOI: 10.1016/s0041-1345(01)02215-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K Ayed
- Immunology Laboratory, EPS, Charles Nicolle, Tunis, Tunisia
| | | | | |
Collapse
|