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Harnois MJ, Drabik A, Snyder L, Reed EF, Chen D, Li Y, Valenzuela NM, Jackson AM. Interrogating post-transplant donor HLA-specific antibody characteristics and effector functions using clinical bead assays. Hum Immunol 2024; 85:111094. [PMID: 39357467 DOI: 10.1016/j.humimm.2024.111094] [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: 01/29/2024] [Revised: 07/31/2024] [Accepted: 09/01/2024] [Indexed: 10/04/2024]
Abstract
Single antigen bead (SAB) assays are the most common and sensitive method used to detect and monitor post-transplant donor specific HLA antibodies (DSA). However, a direct comparison across traditional and modified SAB assays to improve routine DSA monitoring using pre-treated IgG sera to eliminate interference has not been performed. We performed a technical comparison of 251 post-transplant DSA from n = 91 serum samples tested neat (pre-treated, undiluted), at a single 1:16 dilution, in the C1q bead assay, and for IgG subclasses (IgG1, IgG2, IgG3, IgG4) with IgG-enriched sera. We found that DSAs that are detectable by 1:16 dilution and/or C1q are associated with higher IgG MFI values and results could be predicted by testing neat sera. DSA detected at 1:16 dilution correlated with >7000 IgG MFI in neat sera and identified DSA that exceeded the SAB linear range for semiquantitative measurements. C1q positive DSA correlated with >15,000 IgG MFI in neat sera. C1q binding correlated most strongly with total IgG MFI (Spearman r = 0.82, p = 0.002) and not specific subclasses, demonstrating that DSA C1q binding capacity in this cohort is driven by HLA-specific IgG concentration. Evaluation of engineered pan-HLA class I-specific human IgG1 and IgG2 subclass monoclonal antibodies by SAB C1q and C3d assays revealed that IgG2 antibodies can bind complement at higher concentrations. The strengths and limitations of modified SAB assays must be considered to optimize efficient testing and accurate clinical interpretation.
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Affiliation(s)
- Melissa J Harnois
- Department of Immunology, Duke University School of Medicine, Durham, NC, USA; Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Ashley Drabik
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Laurie Snyder
- Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, NC, USA
| | - Elaine F Reed
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA
| | - Dongfeng Chen
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Yan Li
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nicole M Valenzuela
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA
| | - Annette M Jackson
- Department of Immunology, Duke University School of Medicine, Durham, NC, USA; Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
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2
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Abraha J, Rao P, Morris GP. Modes of assay interference and the effectiveness of serum pretreatment approaches in detection of anti-HLA antibodies. J Clin Pathol 2024; 77:284-290. [PMID: 36600574 DOI: 10.1136/jcp-2022-208371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
AIMS Several modes of assay interference common to immunoassays affect solid-phase single-antigen bead-based immunoassays (SAB) used to detect antibodies against human leucocyte antigens (HLA). Best practice recommendations include methods to address assay interference, though the clinical impact and optimal approaches are undefined. We sought to evaluate assay interference in HLA SAB to identify an efficient approach for avoiding erroneous results. METHODS Retrospective analysis of 14 059 patient samples tested for anti-HLA antibodies was performed. This included 4685 samples tested prior to implementation of serum pretreatment with EDTA and 4982 samples tested with routine EDTA treatment using the same testing algorithm. An algorithm for efficiently identifying and processing samples with suspected interference was evaluated in a separate cohort of 4392 EDTA-treated samples. RESULTS EDTA serum pretreatment reduced assay interference, but did not eliminate all modes of interference. A protocol for identification and testing of samples with suspected interference facilitated efficient detection of interference while reducing the amount of additional testing required. CONCLUSIONS Our data indicate that a single-method approach is insufficient to address all sources of interference in HLA SAB. A multimodal approach with a proactive screening is a more effective way to minimise risk of erroneous results.
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Affiliation(s)
- Joseph Abraha
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Ping Rao
- Aurora Health Care, Milwaukee, Wisconsin, USA
| | - Gerald P Morris
- Department of Pathology, University of California San Diego, La Jolla, California, USA
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3
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DeFilippis EM, Kransdorf EP, Jaiswal A, Zhang X, Patel J, Kobashigawa JA, Baran DA, Kittleson MM. Detection and management of HLA sensitization in candidates for adult heart transplantation. J Heart Lung Transplant 2023; 42:409-422. [PMID: 36631340 DOI: 10.1016/j.healun.2022.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 12/28/2022] Open
Abstract
Heart transplantation (HT) remains the preferred therapy for patients with advanced heart failure. However, for sensitized HT candidates who have antibodies to human leukocyte antigens , finding a suitable donor can be challenging and can lead to adverse waitlist outcomes. In recent years, the number of sensitized patients awaiting HT has increased likely due to the use of durable and mechanical circulatory support as well as increasing number of candidates with underlying congenital heart disease. This State-of-the-Art review discusses the assessment of human leukocyte antigens antibodies, potential desensitization strategies including mechanisms of action and specific protocols, the approach to a potential donor including the use of complement-dependent cytotoxicity, flow cytometry, and virtual crossmatches, and peritransplant induction management.
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Affiliation(s)
- Ersilia M DeFilippis
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Evan P Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Abhishek Jaiswal
- Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Xiaohai Zhang
- HLA and Immunogenetics Laboratory, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jignesh Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jon A Kobashigawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - David A Baran
- Cleveland Clinic, Heart Vascular and Thoracic Institute, Weston, Florida
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4
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Rosser C, Sage D. Approaches for the characterization of clinically relevant pre-transplant human leucocyte antigen (HLA) antibodies in solid organ transplant patients. Int J Immunogenet 2021; 48:385-402. [PMID: 34346180 DOI: 10.1111/iji.12552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/30/2021] [Accepted: 07/22/2021] [Indexed: 11/27/2022]
Abstract
The avoidance of antibody-mediated rejection (AMR) attributed to human leucocyte antigen (HLA) antibody incompatibility remains an essential function of clinical Histocompatibility and Immunogenetics (H&I) laboratories who are supporting solid organ transplantation. Developments in HLA antibody identification assays over the past thirty years have greatly reduced unexpected positive cellular crossmatches and improved solid organ transplant outcomes. For sensitized patients, the decision to register unacceptable HLA antigen mismatches is often heavily influenced by results from solid phase antibody assays, particularly the Luminex® Single Antigen Bead (SAB) assays, although the clinical relevance of antibodies identified solely by these assays remains unclear. As such, the identification of non-clinically relevant antibodies may proportionally increase the number of unacceptable transplant mismatches registered, with an associated increase in waiting time for a compatible organ. We reflect on the clinical relevance of antibodies identified solely by the Luminex SAB® assays and consider whether the application of additional assays and/or tools could further develop our ability to define the clinical relevance of antibodies identified in patient sera. Improvements in this area would assist equity of access to a compatible transplant for highly sensitized patients awaiting a solid organ transplant.
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Affiliation(s)
- Carla Rosser
- NHS Blood and Transplant (Tooting), Histocompatibility and Immunogenetics, London, UK
| | - Deborah Sage
- NHS Blood and Transplant (Tooting), Histocompatibility and Immunogenetics, London, UK
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5
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Tambur AR, Campbell P, Chong AS, Feng S, Ford ML, Gebel H, Gill RG, Kelsoe G, Kosmoliaptsis V, Mannon RB, Mengel M, Reed EF, Valenzuela NM, Wiebe C, Dijke IE, Sullivan HC, Nickerson P. Sensitization in transplantation: Assessment of risk (STAR) 2019 Working Group Meeting Report. Am J Transplant 2020; 20:2652-2668. [PMID: 32342639 PMCID: PMC7586936 DOI: 10.1111/ajt.15937] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/01/2020] [Accepted: 04/20/2020] [Indexed: 01/25/2023]
Abstract
The purpose of the STAR 2019 Working Group was to build on findings from the initial STAR report to further clarify the expectations, limitations, perceptions, and utility of alloimmune assays that are currently in use or in development for risk assessment in the setting of organ transplantation. The goal was to determine the precision and clinical feasibility/utility of such assays in evaluating both memory and primary alloimmune risks. The process included a critical review of biologically driven, state-of-the-art, clinical diagnostics literature by experts in the field and an open public forum in a face-to-face meeting to promote broader engagement of the American Society of Transplantation and American Society of Histocompatibility and Immunogenetics membership. This report summarizes the literature review and the workshop discussions. Specifically, it highlights (1) available assays to evaluate the attributes of HLA antibodies and their utility both as clinical diagnostics and as research tools to evaluate the effector mechanisms driving rejection; (2) potential assays to assess the presence of alloimmune T and B cell memory; and (3) progress in the development of HLA molecular mismatch computational scores as a potential prognostic biomarker for primary alloimmunity and its application in research trial design.
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Affiliation(s)
- Anat R. Tambur
- Department of SurgeryComprehensive Transplant CenterNorthwestern UniversityChicagoIllinoisUSA
| | - Patricia Campbell
- Department of Laboratory Medicine & PathologyUniversity of AlbertaEdmontonCanada
| | - Anita S. Chong
- Section of TransplantationDepartment of SurgeryThe University of ChicagoChicagoIllinoisUSA
| | - Sandy Feng
- Department of SurgeryUCSF Medical CenterSan FranciscoCaliforniaUSA
| | - Mandy L. Ford
- Department of Surgery and Emory Transplant CenterEmory UniversityAtlantaGeorgiaUSA
| | - Howard Gebel
- Department of PathologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Ronald G. Gill
- Department of ImmunologyUniversity of ColoradoDenverColoradoUSA
| | - Garnett Kelsoe
- Department of ImmunologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | | | - Roslyn B. Mannon
- Department of MedicineDivision of NephrologyUniversity of Alabama School of MedicineBirminghamAlabamaUSA
| | - Michael Mengel
- Department of Laboratory Medicine & PathologyUniversity of AlbertaEdmontonCanada
| | - Elaine F. Reed
- Department of Pathology and Laboratory MedicineDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Nicole M. Valenzuela
- Department of Pathology and Laboratory MedicineDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Chris Wiebe
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - I. Esme Dijke
- Department of Laboratory Medicine & PathologyUniversity of AlbertaEdmontonCanada
| | - Harold C. Sullivan
- Department of PathologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Peter Nickerson
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada
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6
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Visentin J, Bachelet T, Aubert O, Del Bello A, Martinez C, Jambon F, Guidicelli G, Ralazamahaleo M, Bouthemy C, Cargou M, Congy-Jolivet N, Nong T, Lee JH, Sberro-Soussan R, Couzi L, Kamar N, Legendre C, Merville P, Taupin JL. Reassessment of the clinical impact of preformed donor-specific anti-HLA-Cw antibodies in kidney transplantation. Am J Transplant 2020; 20:1365-1374. [PMID: 31883413 DOI: 10.1111/ajt.15766] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 01/25/2023]
Abstract
Anti-denatured HLA-Cw antibodies are highly prevalent, whereas anti-native HLA-Cw antibodies seem to lead to random flow cytometry crossmatch results. We aimed to reassess crossmatch prediction for anti-HLA-Cw using 2 types of single antigen flow beads (classical beads and beads with diminished expression of denatured HLA), and to compare the pathogenicity of preformed anti-denatured and anti-native HLA-Cw antibodies in kidney transplantation. We performed 135 crossmatches with sera reacting against donor HLA-Cw (classical beads fluorescence ≥500); only 20.6% were positive. Forty-three (31.6%) were anti-denatured HLA antibodies (beads with diminished expression of denatured HLA fluorescence <300); all were crossmatch negative. The correlation between classical beads fluorescence and the crossmatch ratio was low (ρ = 0.178), and slightly higher with beads with diminished expression of denatured HLA (ρ = 0.289). We studied 52 kidney recipients with preformed anti-HLA-Cw donor-specific antibodies. Those with anti-native HLA antibodies experienced more acute and chronic antibody-mediated rejections (P = .006 and .03, respectively), and displayed a lower graft survival (P = .04). Patients with anti-native HLA-Cw antibodies more frequently had previous sensitizing events (P < .000001) or plausibility of their antibody profile according to known anti-native HLA-Cw eplets (P = .0001). Anti-native but not anti-denatured HLA-Cw antibodies are deleterious, which underscores the need for reagents with diminished expression of denatured HLA.
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Affiliation(s)
- Jonathan Visentin
- Laboratoire d'Immunologie et Immunogénétique, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, Bordeaux, France.,Immuno ConcEpT, UMR CNRS 5164, Bordeaux, France
| | - Thomas Bachelet
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France.,CTMR-Clinique Saint Augustin, ELSAN, Bordeaux, France
| | - Olivier Aubert
- Paris Translational Research for Organ Transplant INSERM U970, PARCC, HEGP, Paris, France
| | - Arnaud Del Bello
- Service de Néphrologie et de transplantation d'organes, CHU Rangueil, Toulouse, France.,Université Paul Sabatier, Toulouse, France
| | - Charlie Martinez
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France
| | - Frédéric Jambon
- Université de Bordeaux, Bordeaux, France.,Immuno ConcEpT, UMR CNRS 5164, Bordeaux, France.,Service de Néphrologie, Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France
| | - Gwendaline Guidicelli
- Laboratoire d'Immunologie et Immunogénétique, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Mamy Ralazamahaleo
- Laboratoire d'Immunologie et Immunogénétique, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Charlène Bouthemy
- Laboratoire d'Immunologie et Immunogénétique, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Marine Cargou
- Laboratoire d'Immunologie et Immunogénétique, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Nicolas Congy-Jolivet
- Université Paul Sabatier, Toulouse, France.,Laboratoire d'Immunogénétique Moléculaire, EA 3034, Faculté de Médecine Purpan, IFR150 (INSERM), Toulouse, France.,Service d'Immunologie, CHU de Toulouse, Hôpital de Rangueil, Toulouse, France
| | - Thoa Nong
- One Lambda Inc., Canoga Park, California
| | | | - Rebecca Sberro-Soussan
- Service de Néphrologie-Transplantation Adulte, Hôpital Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France.,Inserm U845, Centre Recherche et Signalisation, Université Paris René Descartes, Paris, France
| | - Lionel Couzi
- Université de Bordeaux, Bordeaux, France.,Immuno ConcEpT, UMR CNRS 5164, Bordeaux, France.,Service de Néphrologie, Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France
| | - Nassim Kamar
- Service de Néphrologie et de transplantation d'organes, CHU Rangueil, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
| | - Christophe Legendre
- Service de Néphrologie-Transplantation Adulte, Hôpital Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France.,Inserm U845, Centre Recherche et Signalisation, Université Paris René Descartes, Paris, France
| | - Pierre Merville
- Université de Bordeaux, Bordeaux, France.,Immuno ConcEpT, UMR CNRS 5164, Bordeaux, France.,Service de Néphrologie, Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France
| | - Jean-Luc Taupin
- Laboratoire d'Immunologie et Immunogénétique, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, Bordeaux, France.,Immuno ConcEpT, UMR CNRS 5164, Bordeaux, France
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7
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Cheng Y, He J, Zhang L, Chen X, Ou S. Evaluation of chemiluminescent immunoassay quantitative detection for pro-gastrin-releasing peptide (ProGRP) in serum and plasma. J Int Med Res 2019; 48:300060519882802. [PMID: 31856626 PMCID: PMC7607052 DOI: 10.1177/0300060519882802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate a newly developed Hybiome ProGRP chemiluminescent assay. METHODS Analytical sensitivity, precision, recovery, and equivalency of serum and plasma, serum stability, and complement interference of the Hybiome ProGRP assay were evaluated. Serum specimens from 318 individuals including 38 small cell lung cancer (SCLC), 65 non-small cell lung cancer (NSCLC), 53 benign lung diseases, and 162 healthy controls were assessed using the Hybiome ProGRP assay and Roche Elecsys ProGRP assay, and the results were compared. RESULTS The Hybiome ProGRP assay showed good analytical sensitivity, precision, and accuracy, and it showed equivalence between serum and plasma and serum stability. The methodological comparison results showed good correlation between the Hybiome and Roche assays (slope, 0.9889; intercept, 1.28). Both the Hybiome and Roche assays showed good ability to distinguish between SCLC and NSCLC. Based on 95% specificity in the NSCLC cohort, a clinical differentiation cut-off for separating SCLC from NSCLC patients was 114 pg/mL for the Hybiome assay and 117 pg/mL for the Roche assay; the AUC was 0.9166 and the sensitivity was 71.05% for Hybiome and 0.9045 and 76.32% for Roche, respectively. CONCLUSION The Hybiome ProGRP chemiluminescent assay shows good analytical performance and good correlation with the Roche Elecsys ProGRP assay.
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Affiliation(s)
- Yizhuang Cheng
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| | - Jing He
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| | - Liping Zhang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| | - Xiufa Chen
- Suzhou Hybiome Biomedical Engineering Co. LTD, Suzhou, Jiangsu, P.R. China
| | - Saiying Ou
- Suzhou Hybiome Biomedical Engineering Co. LTD, Suzhou, Jiangsu, P.R. China
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8
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Abolishing serum interference in detection of HLA antibodies: Who, How, When and Why? Hum Immunol 2019; 80:621-628. [DOI: 10.1016/j.humimm.2019.07.294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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9
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10
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Ravindranath MH, Filippone EJ, Mahowald G, Callender C, Babu A, Saidman S, Ferrone S. Significance of the intraindividual variability of HLA IgG antibodies in renal disease patients observed with different beadsets monitored with two different secondary antibodies on a Luminex platform. Immunol Res 2019; 66:584-604. [PMID: 30324227 PMCID: PMC6244961 DOI: 10.1007/s12026-018-9027-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The accurate measurement of anti-HLA alloantibodies in transplant candidates is required for determining the degree of sensitization and for the listing of unacceptable antigens for organ allocation. Both the configuration of the HLA molecules coated on the beads and the nature of detection antibodies may impede assessment of the presence and strength of anti-HLA IgG- with the Luminex single-antigen-bead assay. Sera antibodies of the end-stage renal disease patients were compared using LIFECODES (LC) and LABScreen (LS) beadsets monitored with polyclonal-Fab (IgHPolyFab) and monoclonal-IgG (FcMonoIgG) second antibodies. Positive results at mean fluorescence intensity (MFI) > 500 (at serum dilution 1/10) were used to calculate panel reactive antibody (cPRA) levels. LS-beadsets are coated with monomeric variants in addition to intact HLA antigens with or without peptides, while LC-beadsets are devoid of monomeric variants and with lesser levels of peptide-free heterodimers. Consequently, IgG antibodies against both classes of HLA were reactive to more antigens with LS than with LC-beadsets. For both classes, MFIs were also frequently higher with LS than with LC. For HLA-I, MFIs were higher with IgHPolyFab than with FcMonoIgG with the exception of sera with MFIs > 5000 where they were comparable. For HLA-II, the reverse occurred, with significantly higher levels with FcMonoIgG regardless of the beadsets. The intraindividual variability observed between beadsets with two detection antibodies elucidates that antigens found as acceptable with one beadset may end up unacceptable with the other beadsets, with the possibility of denying potentially compatible transplants to candidates.
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Affiliation(s)
| | - Edward J Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Grace Mahowald
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Adarsh Babu
- CSRL, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, UK
| | - Susan Saidman
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Soldano Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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11
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Crossing low-level donor-specific antibodies in heart transplantation. Curr Opin Organ Transplant 2019; 24:227-232. [DOI: 10.1097/mot.0000000000000628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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Güleç D, Soyöz M, Koçyiğit AÖ, Pirim I, Ayna TK. Comparison of Single Antigen Bead-Based, Cell-Based, and Solid Phase-Based Crossmatch Methods. Transplant Proc 2019; 51:1016-1020. [PMID: 31101162 DOI: 10.1016/j.transproceed.2019.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
AIM Antibody assessment during pretransplantation term is important to detect donor specific antibodies. These donor-specific antibodies are determined by various crossmatch methods (flow cytometric [FCXM], complement-dependent cytotoxic [CDCXM], and Luminex [LMXM]). Recently, single antigen bead (SAB) assays have been used for the assessment of hypersensitized patients. The aim of this study was to compare sensitivity and specificity of the 3 crossmatch methods in reference to the SAB method. METHOD In this study, 69 hypersensitized patients with high class I and/or class II panel reactive antibodies were tested using the flow cytometric SAB method. Serum samples were cross-matched by 3 crossmatch methods with the cells of a volunteer healthy individual, and the results were evaluated according to HLA and cross-reactive epitope groups (CREGs). RESULTS Sensitivity was found to be better with T FCXM (0.91) and class I LMXM (0.87). Specificity of peripheral blood lymphocyte CDCXM method (1.0) was found to be better than the other 2 methods (0.33 and 0.57, respectively). Sensitivity of class II LMXM (0.88) was found to be better than the others (0.42 for B CDCXM and 0.82 for B FCXM, respectively). The specificity of the B CDCXM, B FCXM, and class II LMXM was similar (0.44, 0.44, and 0.33, respectively). CREGs results were similar to HLA results. CONCLUSION Although CDCXM has high specificity for the detection of anti-HLA antibodies, it has low sensitivity. To increase sensitivity, FCXM or LMXM methods may be used with the CDCXM test. These results will be beneficial for laboratories and clinicians during graft survival and patient health assessment.
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Affiliation(s)
- D Güleç
- Tissue Typing Laboratory, Tepecik Education and Research Hospital, Izmir, Turkey.
| | - M Soyöz
- Tissue Typing Laboratory, Tepecik Education and Research Hospital, Izmir, Turkey; Medical Biology and Genetics Department, Faculty of Medicine, İzmir Katip Celebi University, Izmir, Turkey
| | - A Ö Koçyiğit
- Tissue Typing Laboratory, Tepecik Education and Research Hospital, Izmir, Turkey; Medical Biology and Genetics Department, Faculty of Medicine, İzmir Katip Celebi University, Izmir, Turkey
| | - I Pirim
- Tissue Typing Laboratory, Tepecik Education and Research Hospital, Izmir, Turkey; Medical Biology and Genetics Department, Faculty of Medicine, İzmir Katip Celebi University, Izmir, Turkey
| | - T K Ayna
- Tissue Typing Laboratory, Tepecik Education and Research Hospital, Izmir, Turkey; Medical Biology and Genetics Department, Faculty of Medicine, İzmir Katip Celebi University, Izmir, Turkey
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13
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Dao M, Habès D, Taupin JL, Mussini C, Redon MJ, Suberbielle C, Jacquemin E, Gonzales E, Guettier C. Morphological characterization of chronic antibody-mediated rejection in ABO-identical or ABO-compatible pediatric liver graft recipients. Liver Transpl 2018; 24:897-907. [PMID: 29704327 DOI: 10.1002/lt.25187] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/24/2018] [Accepted: 04/15/2018] [Indexed: 12/17/2022]
Abstract
This study aims to define the morphological profile associated with the presence of donor-specific antibodies (DSAs) and/or C4d immunostaining in ABO-identical or compatible pediatric liver grafts. Ten-year protocol liver graft biopsies performed at 131.3 ± 15.3 months after transplantation in 53 pediatric liver graft recipients were reviewed. Immunostaining for C4d was systematically performed and semiquantitatively analyzed. DSAs were concurrently quantified, and results were available for 44 patients. All biopsies demonstrated fibrotic changes with a mean liver allograft fibrosis score (LAFSc) of 5.1 ± 2.2. A total of 31 (58%) biopsies exhibited C4d positivity. DSAs were detected in 20 (45%) patients, and mean maximal mean fluorescence intensity was 12,977 ± 6731. LAFSc (6.3 ± 1.3 versus 3.9 ± 2.2; P = 0.008), perivenular fibrosis (2.7 ± 0.5 versus 1.3 ± 1.0; P < 0.001), and portal inflammation (1.4 ± 0.8 versus 0.3 ± 0.5; P = 0.009) were significantly higher in the double-DSA and C4d-positive group versus the double-negative group. We defined a histological scoring system from these results, which was integrated with the 2016 Banff definition and allowed reclassifying patients for the diagnosis of chronic active antibody-mediated rejection (cAMR; 11/53 versus 13/53). Diagnoses of probable cAMR according to Banff 2016 (n = 4) were unchanged, but 2 among the 9 patients classified as possible cAMR according to the 2016 Banff definition were excluded for this diagnostic when using our histological score. In conclusion, our results confirmed that perivenular fibrosis and portal inflammation in late pediatric liver graft biopsies are features of cAMR. Our histological score could improve the accuracy of the 2016 Banff definition for the diagnosis of cAMR. Liver Transplantation 24 897-907 2018 AASLD.
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Affiliation(s)
- Myriam Dao
- Pathology Department, Centre Hospitalier Universitaire Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Dalila Habès
- Pediatric Hepatology and Pediatric Liver Transplantation Unit, Centre Hospitalier Universitaire Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean-Luc Taupin
- Immunology and Histocompatibility Department, Saint Louis Hospital, Paris, France
| | - Charlotte Mussini
- Pathology Department, Centre Hospitalier Universitaire Bicêtre, Le Kremlin-Bicêtre, France
| | - Marie-José Redon
- Pathology Department, Centre Hospitalier Universitaire Bicêtre, Le Kremlin-Bicêtre, France
| | - Caroline Suberbielle
- Immunology and Histocompatibility Department, Saint Louis Hospital, Paris, France
| | - Emmanuel Jacquemin
- Pediatric Hepatology and Pediatric Liver Transplantation Unit, Centre Hospitalier Universitaire Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Sud, Le Kremlin-Bicêtre, France
- INSERM, Unité Mixte de Recherche en Santé 1174, Université Paris Sud 11, Orsay, France
- Département Hospitalo-Universitaire Hepatinov, Villejuif, France
| | - Emmanuel Gonzales
- Pediatric Hepatology and Pediatric Liver Transplantation Unit, Centre Hospitalier Universitaire Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Sud, Le Kremlin-Bicêtre, France
- INSERM, Unité Mixte de Recherche en Santé 1174, Université Paris Sud 11, Orsay, France
- Département Hospitalo-Universitaire Hepatinov, Villejuif, France
| | - Catherine Guettier
- Pathology Department, Centre Hospitalier Universitaire Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Sud, Le Kremlin-Bicêtre, France
- Département Hospitalo-Universitaire Hepatinov, Villejuif, France
- INSERM, Unité 1193, Villejuif, France
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14
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Bouquegneau A, Loheac C, Aubert O, Bouatou Y, Viglietti D, Empana J, Ulloa C, Hassan Murad M, Legendre C, Glotz D, Jackson AM, Zeevi A, Schaub S, Taupin J, Reed EF, Friedewald JJ, Tyan DB, Süsal C, Shapiro R, Woodle ES, Hidalgo LG, O’Leary J, Montgomery RA, Kobashigawa J, Jouven X, Jabre P, Lefaucheur C, Loupy A. Complement-activating donor-specific anti-HLA antibodies and solid organ transplant survival: A systematic review and meta-analysis. PLoS Med 2018; 15:e1002572. [PMID: 29799874 PMCID: PMC5969739 DOI: 10.1371/journal.pmed.1002572] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/26/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Anti-human leukocyte antigen donor-specific antibodies (anti-HLA DSAs) are recognized as a major barrier to patients' access to organ transplantation and the major cause of graft failure. The capacity of circulating anti-HLA DSAs to activate complement has been suggested as a potential biomarker for optimizing graft allocation and improving the rate of successful transplantations. METHODS AND FINDINGS To address the clinical relevance of complement-activating anti-HLA DSAs across all solid organ transplant patients, we performed a meta-analysis of their association with transplant outcome through a systematic review, from inception to January 31, 2018. The primary outcome was allograft loss, and the secondary outcome was allograft rejection. A comprehensive search strategy was conducted through several databases (Medline, Embase, Cochrane, and Scopus). A total of 5,861 eligible citations were identified. A total of 37 studies were included in the meta-analysis. Studies reported on 7,936 patients, including kidney (n = 5,991), liver (n = 1,459), heart (n = 370), and lung recipients (n = 116). Solid organ transplant recipients with circulating complement-activating anti-HLA DSAs experienced an increased risk of allograft loss (pooled HR 3.09; 95% CI 2.55-3.74, P = 0.001; I2 = 29.3%), and allograft rejection (pooled HR 3.75; 95% CI: 2.05-6.87, P = 0.001; I2 = 69.8%) compared to patients without complement-activating anti-HLA DSAs. The association between circulating complement-activating anti-HLA DSAs and allograft failure was consistent across all subgroups and sensitivity analyses. Limitations of the study are the observational and retrospective design of almost all included studies, the higher proportion of kidney recipients compared to other solid organ transplant recipients, and the inclusion of fewer studies investigating allograft rejection. CONCLUSIONS In this study, we found that circulating complement-activating anti-HLA DSAs had a significant deleterious impact on solid organ transplant survival and risk of rejection. The detection of complement-activating anti-HLA DSAs may add value at an individual patient level for noninvasive biomarker-guided risk stratification. TRIAL REGISTRATION National Clinical Trial protocol ID: NCT03438058.
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Affiliation(s)
- Antoine Bouquegneau
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Nephrology, Dialysis and Transplantation, CHU de Liège, Liège, Belgium
| | - Charlotte Loheac
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
| | - Olivier Aubert
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Kidney Transplantation, Necker Hospital, Paris Descartes University, and Assistance Publique–Hôpitaux de Paris (AP–HP), Paris, France
| | - Yassine Bouatou
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland
| | - Denis Viglietti
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Nephrology and Kidney Transplantation, Saint–Louis Hospital, Paris Diderot University, AP–HP, Paris, France
| | - Jean–Philippe Empana
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
| | - Camilo Ulloa
- Hospital Barros Luco Trudeau, Santiago, Chile et Clinica Alemana de Santiago, Chile
| | - Mohammad Hassan Murad
- Mayo Clinic Evidence–based Practice Center, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Christophe Legendre
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Kidney Transplantation, Necker Hospital, Paris Descartes University, and Assistance Publique–Hôpitaux de Paris (AP–HP), Paris, France
| | - Denis Glotz
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Nephrology and Kidney Transplantation, Saint–Louis Hospital, Paris Diderot University, AP–HP, Paris, France
| | - Annette M. Jackson
- Immunogenetics Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Adriana Zeevi
- Department of Pathology, Surgery and Immunology at University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Stephan Schaub
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Jean–Luc Taupin
- Department of Immunology and Histocompatibility, CHU Paris–GH St–Louis Lariboisière, Paris, France
| | - Elaine F. Reed
- Department of Pathology and Laboratory Medicine, UCLA Immunogenetics Center, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - John J. Friedewald
- Northwestern University Feinberg School of Medicine, Comprehensive Transplant Center, Division of Transplant Surgery, Chicago, Illinois, United states of America
| | - Dolly B. Tyan
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Caner Süsal
- Institute of Immunology, Heidelberg University, Department of Transplantation Immunology, Heidelberg, Germany
| | - Ron Shapiro
- Kidney/Pancreas Transplant Program, Mount Sinai Hospital, Recanati Miller Transplantation Institute, New York, New York, United States of America
| | - E. Steve Woodle
- Division of Transplantation, Department of Surgery, and Division of Hematology and Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Luis G. Hidalgo
- Department of Laboratory Medicine and Pathology and Alberta Transplant Applied Genomics Center, Edmonton, Alberta, Canada
| | - Jacqueline O’Leary
- Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, United States of America
| | - Robert A. Montgomery
- The NYU Transplant Institute, New York University Langone Medical Center, New York, New York, United States of America
| | - Jon Kobashigawa
- Cedars–Sinai Heart Institute, Los Angeles, California, United States of America
| | - Xavier Jouven
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Cardiology and Global Health Unit European Georges Pompidou Hospital, Paris
| | - Patricia Jabre
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- SAMU of Paris, Necker Hospital Paris, France
- Paris Descartes University, Paris, France
- AP–HP, Paris, France
| | - Carmen Lefaucheur
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Nephrology and Kidney Transplantation, Saint–Louis Hospital, Paris Diderot University, AP–HP, Paris, France
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Kidney Transplantation, Necker Hospital, Paris Descartes University, and Assistance Publique–Hôpitaux de Paris (AP–HP), Paris, France
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15
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Guidicelli G, Visentin J, Franchini N, Borg C, Merville P, Couzi L, Taupin JL. Prevalence, distribution and amplitude of the complement interference phenomenon in single antigen flow beads assays. HLA 2018; 91:507-513. [DOI: 10.1111/tan.13263] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- G. Guidicelli
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique; Hôpital Pellegrin; Bordeaux France
| | - J. Visentin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique; Hôpital Pellegrin; Bordeaux France
- Université de Bordeaux; Bordeaux France
- Immuno ConcEpT, UMR CNRS 5164; Bordeaux France
| | - N. Franchini
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique; Hôpital Pellegrin; Bordeaux France
| | - C. Borg
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique; Hôpital Pellegrin; Bordeaux France
| | - P. Merville
- Université de Bordeaux; Bordeaux France
- Immuno ConcEpT, UMR CNRS 5164; Bordeaux France
- CHU de Bordeaux, Service de Néphrologie, Transplantation, Dialyse et Aphérèses; Bordeaux France
| | - L. Couzi
- Université de Bordeaux; Bordeaux France
- Immuno ConcEpT, UMR CNRS 5164; Bordeaux France
- CHU de Bordeaux, Service de Néphrologie, Transplantation, Dialyse et Aphérèses; Bordeaux France
| | - J.-L. Taupin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique; Hôpital Pellegrin; Bordeaux France
- Université de Bordeaux; Bordeaux France
- Immuno ConcEpT, UMR CNRS 5164; Bordeaux France
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16
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Roux A, Bendib Le Lan I, Holifanjaniaina S, Thomas KA, Picard C, Grenet D, De Miranda S, Douvry B, Beaumont-Azuar L, Sage E, Devaquet J, Cuquemelle E, Le Guen M, Suberbielle C, Gautreau C, Stern M, Rossetti M, Hamid AM, Parquin F. Characteristics of Donor-Specific Antibodies Associated With Antibody-Mediated Rejection in Lung Transplantation. Front Med (Lausanne) 2017; 4:155. [PMID: 29075627 PMCID: PMC5641623 DOI: 10.3389/fmed.2017.00155] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/08/2017] [Indexed: 11/13/2022] Open
Abstract
Although donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) are frequently found in recipients after lung transplantation (LT), the characteristics of DSA which influence antibody-mediated rejection (AMR) in LT are not fully defined. We retrospectively analyzed 206 consecutive LT patients of our center (2010–2013). DSAs were detected by using luminex single antigen beads assay and mean fluorescence intensity was assessed. Within the study population, 105 patients had positive DSA. Patients with and without AMR (AMRPos, n = 22, and AMRNeg, n = 83, respectively) were compared. AMRPos patients had significantly greater frequencies of anti-HLA DQ DSA (DQ DSA) than AMRNeg patients (95 vs 58%, respectively, p < 0.0001). Compared to AMRNeg patients, AMRPos patients had higher DQ DSA sum MFI [7,332 (2,067–10,213) vs 681 (0–1,887), p < 0.0001]. DQ DSA when associated with AMR, had more frequent graft loss and chronic lung allograft dysfunction (CLAD). These data suggest (i) that DSA characteristics clearly differ between AMRPos and AMRNeg patients and (ii) the deleterious impact of DQ DSA on clinical outcome.
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Affiliation(s)
- Antoine Roux
- Pneumology, Adult CF Center, Lung Transplantation Department, Foch Hospital, Suresnes, France.,Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Université Versailles Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Ines Bendib Le Lan
- Pneumology, Adult CF Center, Lung Transplantation Department, Foch Hospital, Suresnes, France
| | | | - Kimberly A Thomas
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Clément Picard
- Pneumology, Adult CF Center, Lung Transplantation Department, Foch Hospital, Suresnes, France
| | - Dominique Grenet
- Pneumology, Adult CF Center, Lung Transplantation Department, Foch Hospital, Suresnes, France
| | - Sandra De Miranda
- Pneumology, Adult CF Center, Lung Transplantation Department, Foch Hospital, Suresnes, France
| | - Benoit Douvry
- Pneumology, Adult CF Center, Lung Transplantation Department, Foch Hospital, Suresnes, France
| | - Laurence Beaumont-Azuar
- Pneumology, Adult CF Center, Lung Transplantation Department, Foch Hospital, Suresnes, France
| | - Edouard Sage
- Université Versailles Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France.,Thoracic Surgery Department, Foch Hospital, Suresnes, France
| | | | | | - Morgan Le Guen
- Anesthesiology Department, Foch Hospital, Suresnes, France
| | - Caroline Suberbielle
- Laboratoire Régional d'Histocompatibilité, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Chantal Gautreau
- Laboratoire Régional d'Histocompatibilité, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Stern
- Pneumology, Adult CF Center, Lung Transplantation Department, Foch Hospital, Suresnes, France
| | - Maura Rossetti
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Abdul Monem Hamid
- Pneumology, Adult CF Center, Lung Transplantation Department, Foch Hospital, Suresnes, France
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17
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Zhang X, Reinsmoen NL. Comprehensive assessment for serum treatment for single antigen test for detection of HLA antibodies. Hum Immunol 2017; 78:699-703. [PMID: 28899793 DOI: 10.1016/j.humimm.2017.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
The single antigen test is widely used in the field of transplantation to determine the specificity of HLA antibodies. It will be beneficial to standardize the procedure of the single antigen test among HLA laboratories. It is not uncommon that single antigen testing on native sera fails to detect antibodies with very high concentrations. It has been shown that cleavage products of activated complement components may mask strongly binding antibodies in single antigen testing. To overcome inhibition by the activated complement products, sera are pretreated with ethylenediaminetetraacetic acid (EDTA), dithiothreitol (DTT), or heat inactivation before single antigen testing. However, no studies have been published to systemically compare the impact of these treatments on single antigen testing. The aim of this study is to understand the different effects these treatments may have on single antigen test results. We found that mean fluorescence intensity (MFI) obtained from sera treated with EDTA and heat inactivation were nearly identical, while DTT treatment was less potent to remove the inhibition. In addition, sera dilution did not further increase MFI of antibodies after EDTA treatment. Our results provide guidance to choose a pretreatment reagent for single antigen testing, and to compare studies obtained from laboratories using different treatments.
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Affiliation(s)
- Xiaohai Zhang
- HLA and Immunogenetics Laboratory, Comprehensive Transplant Center, Cedars-Sinai Health System, 8723 Alden Drive, SSB 197, Los Angeles, CA 90048, United States.
| | - Nancy L Reinsmoen
- HLA and Immunogenetics Laboratory, Comprehensive Transplant Center, Cedars-Sinai Health System, 8723 Alden Drive, SSB 197, Los Angeles, CA 90048, United States
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18
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Technical Limitations of the C1q Single-Antigen Bead Assay to Detect Complement Binding HLA-Specific Antibodies. Transplantation 2017; 101:1206-1214. [PMID: 27306532 PMCID: PMC5457814 DOI: 10.1097/tp.0000000000001270] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Solid-phase assays to distinguish complement binding from noncomplement binding HLA-specific antibodies have been introduced, but technical limitations may compromise their interpretation. We have examined the extent to which C1q-binding to HLA-class I single-antigen beads (SAB) is influenced by denatured HLA on SAB, antibody titre, and complement interference that causes a misleading low assessment of HLA-specific antibody levels. METHODS Sera from 25 highly sensitized patients were tested using Luminex IgG-SAB and C1q-SAB assays. Sera were tested undiluted, at 1:20 dilution to detect high-level IgG, and after ethylene diamine tetraacetic acid treatment to obviate complement interference. Conformational HLA and denatured HLA protein levels on SAB were determined using W6/32 and HC-10 monoclonal antibodies, respectively. Denatured HLA was expressed as HC-10 binding to untreated SAB as a percentage of maximal binding to acid-treated SAB. RESULTS For undiluted sera, Luminex mean fluorescence intensity (MFI) values for IgG-SAB and C1q-SAB correlated poorly (r = 0.42). ethylene diamine tetraacetic acid and serum dilution improved the correlation (r = 0.57 and 0.77, respectively). Increasing levels of denatured HLA interfered with the detection of C1q binding. Consequently, the correlation between IgG-SAB MFI and C1q-SAB MFI was lowest using undiluted sera and SAB with greater than 30% denatured HLA (r = 0.40) and highest using diluted sera and SAB with 30% or less denatured HLA (r = 0.86). CONCLUSIONS Antibody level, complement interference, and denatured HLA class I on SAB may all affect the clinical interpretation of the C1q-SAB assay. The C1q-SAB assay represents a substantial additional cost for routine clinical use, and we question its justification given the potential uncertainty about its interpretation.
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19
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Quantitative Evaluation of the Impact of Ethylenediaminetetraacetic Acid Pretreatment on Single-Antigen Bead Assay. Transplant Direct 2017; 3:e194. [PMID: 28795145 PMCID: PMC5540632 DOI: 10.1097/txd.0000000000000709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/23/2017] [Indexed: 01/28/2023] Open
Abstract
Background Ethylenediaminetetraacetic acid (EDTA) pretreatment has been shown to overcome complement interference in the single-antigen bead (SAB) assay. However, a quantitative evaluation of its impact on the assay for preemptive application to diverse clinical samples is still lacking. Methods Serum samples from 95 renal transplant candidates were tested with and without EDTA-pretreatment in parallel. Changes in mean fluorescence intensity (MFI) values were analyzed to determine the impact of EDTA-pretreatment and the characteristics of complement interference. Results MFI values from EDTA-treated and untreated sera showed good correlations (r = 0.99) and were linear after excluding outliers (slopes, 1; intercepts, −63.7 and −24.2 for class I and II, respectively). Using an assay cutoff of 2000 MFI, positive/negative assignments were concordant for 99% of the 9215 class I beads and 9025 class II beads tested. As defined by an MFI increment above 4000 after EDTA pretreatment, complement interference affected 172 class I beads in 12 samples (12.6%) and 60 class II beads in 7 samples (7.4%), and the findings were supported in 83% and 86% of these samples by dilution studies. In a case study, EDTA pretreatment prevented falsely low MFI values and facilitated the interpretation of titration curves. Finally, EDTA pretreatment reduced the coefficient of variance (CV) by 2.1% and 2.4% for class I and II beads respectively (P < 0.0001). Conclusions It is safe to preemptively treat all clinical samples with EDTA before SAB assay to prevent false negative results or falsely low MFI values. EDTA pretreatment has the added benefit of improved assay precision.
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20
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Sullivan HC, Gebel HM, Bray RA. Understanding solid-phase HLA antibody assays and the value of MFI. Hum Immunol 2017; 78:471-480. [DOI: 10.1016/j.humimm.2017.05.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 01/10/2023]
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21
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Desoutter J, Apithy MJ, Guillaume N. Unexpected Positive Prospective Crossmatches in Organ Transplant. EXP CLIN TRANSPLANT 2017; 15:253-259. [PMID: 28447927 DOI: 10.6002/ect.2016.0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Preformed donor-specific antibodies against human leukocyte antigen can induce antibody-mediated rejection after organ transplant. Hence, future transplant recipients undergo pretransplant screening for preformed antibodies (ie, virtual crossmatch). Subsequently, prospective (analytic) crossmatching is performed using conventional, complement-dependent cytotoxicity assays and/or flow cytometry-based methods. The present article reviews factors that must be considered when unexpected, positive, prospective crossmatches are observed. First, the prozone effect caused by the interference of complement or immunoglobulin M must be abrogated by treating the serum with moderate heat, dilution, hypotonic dialysis, EDTA, or dithiothreitol. Second, the physician must check for the presence of potentially interfering autoantibodies (in a context of autoimmune disease or human immunodeficiency virus infection) or therapeutic antibodies (such as rituximab and antithymocyte globulin). In conclusion, knowledge of each assay's technical characteristics will enable the physician to reliably interpret any discrepancies. The reasons for an unexpected, positive, prospective crossmatch must be elucidated before transplant to ensure efficient organ allocation and optimize patient outcomes.
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Affiliation(s)
- Judith Desoutter
- From the Department of Histocompatibility, Amiens University Medical Center, Amiens, France
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22
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Reassessment of T Lymphocytes Crossmatches Results Prediction With Luminex Class I Single Antigen Flow Beads Assay. Transplantation 2017; 101:624-630. [DOI: 10.1097/tp.0000000000001239] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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23
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Irure J, Asensio E, Rodrigo E, Romón Í, Gómez J, Arias M, López-Hoyos M, San Segundo D. Improvement in the definition of anti-HLA antibody profile in highly sensitized patients. PLoS One 2017; 12:e0171463. [PMID: 28158255 PMCID: PMC5291387 DOI: 10.1371/journal.pone.0171463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/20/2017] [Indexed: 11/20/2022] Open
Abstract
The definition of anti-HLA antibody profile in highly sensitized patients on a waiting list is crucial when virtual crossmatch is used in organ allocation systems, but also when used to identify the true deleterious anti-HLA antibodies. Here we propose different levels of risk based on the results of anti-HLA antibody testing in neat serum (N) and after sera dilution (DIL) and C1q test in 18 highly sensitized patients. This group was heterogeneous in terms of anti-HLA antibody titers and their ability to fix complement. After dilution, 15 out of 18 patients (83.3%) showed a reduction of positive bead counts whereas 4 patients showed a prozone effect and complement fixation was demonstrated. The high dilution of sera and ascertaining the complement fixation allow the accurate definition of risk anti-HLA antibody profiles in highly sensitized patients, as demonstrated in 5 of the sensitized patients who were transplanted.
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Affiliation(s)
- Juan Irure
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Esther Asensio
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Emilio Rodrigo
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Íñigo Romón
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Javier Gómez
- Pathology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Manuel Arias
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Marcos López-Hoyos
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - David San Segundo
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
- * E-mail:
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24
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Jani V, Ingulli E, Mekeel K, Morris GP. Root cause analysis of limitations of virtual crossmatch for kidney allocation to highly-sensitized patients. Hum Immunol 2017; 78:72-79. [DOI: 10.1016/j.humimm.2016.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
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25
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Milongo D, Kamar N, Del Bello A, Guilbeau-Frugier C, Sallusto F, Esposito L, Dörr G, Blancher A, Congy-Jolivet N. Allelic and Epitopic Characterization of Intra-Kidney Allograft Anti-HLA Antibodies at Allograft Nephrectomy. Am J Transplant 2017; 17:420-431. [PMID: 27402017 DOI: 10.1111/ajt.13958] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/24/2016] [Accepted: 06/25/2016] [Indexed: 01/25/2023]
Abstract
The reasons for the increased incidence of de novo anti-human leukocyte antibody (HLA) donor-specific antibodies (DSAs) observed after kidney allograft nephrectomy are not fully understood. One advocated mechanism suggests that at graft loss, DSAs are not detected in the serum because they are fixed on the nonfunctional transplant; removal of the kidney allows DSAs to then appear in the blood circulation. The aim of our study was to compare anti-HLA antibodies present in the serum and in the graft at the time of an allograft nephrectomy. Using solid-phase assays, anti-HLA antibodies were searched for in the sera of 17 kidney transplant patients undergoing allograft nephrectomy. No anti-HLA antibodies were detected in the graft if they were not also detected in the serum. Eleven of the 12 patients who had DSAs detected in their sera also had DSAs detected in the grafts. Epitopic analysis revealed that most anti-HLA antibodies detected in removed grafts were directed against the donor. In summary, our data show that all anti-HLA antibodies that were detected in grafts were also detected in the sera. These intragraft anti-HLA antibodies are mostly directed against the donor at an epitopic level but not always at an antigenic level.
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Affiliation(s)
- D Milongo
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,Université Paul Sabatier, Toulouse, France
| | - N Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
| | - A Del Bello
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,Université Paul Sabatier, Toulouse, France
| | - C Guilbeau-Frugier
- Université Paul Sabatier, Toulouse, France.,Department of Pathology, CHU Toulouse, Toulouse, France
| | - F Sallusto
- Department of Urology and Kidney Transplantation, CHU Toulouse, Toulouse, France
| | - L Esposito
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - G Dörr
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,Université Paul Sabatier, Toulouse, France
| | - A Blancher
- Université Paul Sabatier, Toulouse, France.,Molecular Immunogenetics Laboratory, EA 3034, Faculté de Médecine Purpan, IFR150 (INSERM), Toulouse, France.,Department of Immunology, CHU de Toulouse, Hôpital de Rangueil, Toulouse, France
| | - N Congy-Jolivet
- Université Paul Sabatier, Toulouse, France.,Molecular Immunogenetics Laboratory, EA 3034, Faculté de Médecine Purpan, IFR150 (INSERM), Toulouse, France.,Department of Immunology, CHU de Toulouse, Hôpital de Rangueil, Toulouse, France
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26
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Halloran PF, Famulski KS, Chang J. A Probabilistic Approach to Histologic Diagnosis of Antibody-Mediated Rejection in Kidney Transplant Biopsies. Am J Transplant 2017; 17:129-139. [PMID: 27340822 DOI: 10.1111/ajt.13934] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 01/25/2023]
Abstract
Histologic diagnosis of antibody-mediated rejection (ABMR) in kidney transplant biopsies uses lesion score cutoffs such as 0 versus >0 rather than actual scores and requires donor-specific antibody (DSA); however, cutoffs lose information, and DSA is not always reliable. Using microarray-derived molecular ABMR scores as a histology-independent estimate of ABMR in 703 biopsies, we reassessed criteria for ABMR to determine relative importance of various lesions, the utility of equations using actual scores rather than cutoffs, and the potential for diagnosing ABMR when DSA is unknown or negative. We confirmed that the important features for ABMR diagnosis were peritubular capillaritis (ptc), glomerulitis (g), glomerular double contours, DSA and C4d staining, but we questioned some features: arterial fibrosis, vasculitis, acute tubular injury, and sum of ptc+g scores. Regression equations using lesion scores predicted molecular ABMR more accurately than score cutoffs (area under the curve 0.85-0.86 vs. 0.75). DSA positivity improved accuracy, but regression equations predicted ABMR with moderate accuracy when DSA was unknown. Some biopsies without detectable DSA had high probability of ABMR by regression, although most had HLA antibody. We concluded that regression equations using lesion scores plus DSA maximized diagnostic accuracy and can estimate probable ABMR when DSA is unknown or undetectable.
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Affiliation(s)
- P F Halloran
- Alberta Transplant Applied Genomics Centre, Edmonton, AB, Canada.,Department of Medicine, Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada
| | - K S Famulski
- Alberta Transplant Applied Genomics Centre, Edmonton, AB, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - J Chang
- Alberta Transplant Applied Genomics Centre, Edmonton, AB, Canada
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27
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Visentin J, Chartier A, Massara L, Linares G, Guidicelli G, Blanchard E, Parrens M, Begueret H, Dromer C, Taupin JL. Lung intragraft donor-specific antibodies as a risk factor for graft loss. J Heart Lung Transplant 2016; 35:1418-1426. [DOI: 10.1016/j.healun.2016.06.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 06/03/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022] Open
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28
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Caillard S, Becmeur C, Gautier-Vargas G, Olagne J, Muller C, Cognard N, Perrin P, Braun L, Heibel F, Lefebre F, Renner V, Gachet C, Moulin B, Parissiadis A. Pre-existing donor-specific antibodies are detrimental to kidney allograft only when persistent after transplantation. Transpl Int 2016; 30:29-40. [DOI: 10.1111/tri.12864] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/21/2016] [Accepted: 09/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Sophie Caillard
- Department of Nephrology; Division of Renal Transplantation; University Hospital of Strasbourg; Strasbourg France
| | - Camille Becmeur
- Department of Nephrology; Division of Renal Transplantation; University Hospital of Strasbourg; Strasbourg France
| | - Gabriela Gautier-Vargas
- Department of Nephrology; Division of Renal Transplantation; University Hospital of Strasbourg; Strasbourg France
| | - Jerome Olagne
- Department of Nephrology; Division of Renal Transplantation; University Hospital of Strasbourg; Strasbourg France
- Department of Nephropathology; University Hospital of Strasbourg; Strasbourg France
| | - Clotilde Muller
- Department of Nephrology; Division of Renal Transplantation; University Hospital of Strasbourg; Strasbourg France
| | - Noelle Cognard
- Department of Nephrology; Division of Renal Transplantation; University Hospital of Strasbourg; Strasbourg France
| | - Peggy Perrin
- Department of Nephrology; Division of Renal Transplantation; University Hospital of Strasbourg; Strasbourg France
| | - Laura Braun
- Department of Nephrology; Division of Renal Transplantation; University Hospital of Strasbourg; Strasbourg France
| | - Francoise Heibel
- Department of Nephrology; Division of Renal Transplantation; University Hospital of Strasbourg; Strasbourg France
| | - Francois Lefebre
- Public Health Department; University Hospital of Strasbourg; Strasbourg France
| | - Veronique Renner
- Histocompatibility Laboratory; UMR_S949 Inserm; Strasbourg France
| | - Christian Gachet
- Histocompatibility Laboratory; UMR_S949 Inserm; Strasbourg France
| | - Bruno Moulin
- Department of Nephrology; Division of Renal Transplantation; University Hospital of Strasbourg; Strasbourg France
| | - Anne Parissiadis
- Histocompatibility Laboratory; UMR_S949 Inserm; Strasbourg France
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29
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Anani WQ, Zeevi A, Lunz JG. EDTA Treatment of Serum Unmasks Complement-Mediated Prozone Inhibition in Human Leukocyte Antigen Antibody Testing. Am J Clin Pathol 2016; 146:346-52. [PMID: 27543980 DOI: 10.1093/ajcp/aqw116] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Luminex-based single-antigen bead human leukocyte antigen (HLA) antibody testing is widely used to define HLA antibodies for transplant compatibility. False-negative results can occur with complement-mediated prozone inhibition. This study assessed the effect of EDTA on the assay background reactivity and fluctuations in antibody mean fluorescent intensity. METHODS Serum specimens were retrospectively tested using Luminex-based single-antigen beads with and without EDTA. Treated and untreated serum samples were compared by two measures: changes in background reactivity and changes in HLA antibody strength after EDTA treatment. RESULTS Ten pretransplant and 48 posttransplant specimens were identified: lung (22), heart (10), kidney (21), heart/lung (two), pancreas (one), small bowel (one), and liver (one). After EDTA treatment, weak antibodies (below 2,000 mean florescent intensity) demonstrated the largest fluctuations. Newly identified HLA antibodies were seen in 16% (8/49) of class I and 26% (15/57) of class II beads. EDTA treatment did not result in false-negative reactions compared with untreated serum. CONCLUSIONS EDTA serum pretreatment mitigated complement-mediated prozone inhibition and improved accurate HLA antibody detection. The background reactivity and the false-negative rate of the assay appear unchanged.
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Affiliation(s)
- Waseem Q Anani
- From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Adriana Zeevi
- From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John G Lunz
- From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA.
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30
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Zhao J, Fu YX, Yang T, Shen ZY, Wu CL. Prediction of Complement-Binding Capacity of HLA Antibodies Based on Mean Fluorescence Intensity. Transplant Proc 2016; 48:2235-40. [PMID: 27569975 DOI: 10.1016/j.transproceed.2016.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 03/23/2016] [Accepted: 04/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Human leukocyte antigen (HLA) antibodies estimated by Luminex single-antigen beads, especially those that fix complement, are associated with antibody-mediated rejection and graft failure. However, the relationship between HLA antibody strength and complement-binding ability is controversial. METHODS Serum samples of 31 sensitized renal patients waiting for renal transplantation were retrospectively analyzed by IgG-Luminex to identify HLA antibodies and in parallel by C1q-Luminex to determine the complement binding of HLA antibodies. RESULTS The percentage of HLA class I antibodies binding with C1q was lower than that of HLA class II antibodies (43.2% vs. 51.3%, P = .006). The mean fluorescence intensities (MFI) of IgG-Luminex correlated with the MFI of C1q-Luminex for the same antibodies (Spearman correlation; class I, r = 0.665, P < .01; class II, r = 0.761, P < .01). Receiver operating characteristic (ROC) curve analysis showed that the MFIs of HLA antibodies by IgG-Luminex predicted their C1q-binding abilities (area under the curve [AUC] class I = 0.917; AUC class II = 0.927). Using MFI cutoff values of 8238 and 6754 in IgG-Luminex for HLA class I and class II antibodies, respectively, the sensitivity and specificity for C1q binding were 82.4% and 87.4% for class I antibodies and 90.9% and 82% for class II antibodies. CONCLUSIONS The MFI of HLA antibodies by IgG-Luminex predicts the complement-binding capability to a certain extent before transplantation.
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Affiliation(s)
- J Zhao
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China; Department of Transplant Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Y X Fu
- Department of Transplant Surgery, Tianjin First Central Hospital, Tianjin, China
| | - T Yang
- Department of Transplant Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Z Y Shen
- Department of Transplant Surgery, Tianjin First Central Hospital, Tianjin, China
| | - C L Wu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China.
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31
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Carey BS, Boswijk K, Mabrok M, Rowe PA, Connor A, Saif I, Poles A. A reliable method for avoiding false negative results with Luminex single antigen beads; evidence of the prozone effect. Transpl Immunol 2016; 37:23-27. [PMID: 27109036 DOI: 10.1016/j.trim.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/10/2016] [Accepted: 04/15/2016] [Indexed: 11/28/2022]
Abstract
Luminex single antigen bead (SAB) assays have become an essential tool in monitoring the status of antibody to the Human Leucocyte Antigen (HLA) of patients both before and after transplantation. In addition SAB data is used to aid risk stratification to assess immunological risk of humoral rejection in solid organ transplantation (CTAG/BTAG guidelines) [1]. Increasingly laboratories are reporting false negative results at high antibody titre due to a prozone effect. Here we report a case study where the prozone effect led to a false negative antibody result that could have resulted in adverse outcome. We describe a method to reliably remove the prozone effect through heat inactivation and the addition of Ethylenediaminetetraacetic acid (EDTA) to the Luminex wash buffer.
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Affiliation(s)
- B Sean Carey
- H&I, Combined Labs, Derriford Hospital, Plymouth, United Kingdom.
| | - Kim Boswijk
- H&I, Combined Labs, Derriford Hospital, Plymouth, United Kingdom
| | - Mazen Mabrok
- H&I, Combined Labs, Derriford Hospital, Plymouth, United Kingdom
| | - Peter A Rowe
- South West Transplant Centre, Derriford Hospital, Plymouth, United Kingdom
| | - Andrew Connor
- South West Transplant Centre, Derriford Hospital, Plymouth, United Kingdom
| | - Imran Saif
- South West Transplant Centre, Derriford Hospital, Plymouth, United Kingdom
| | - Anthony Poles
- H&I, Combined Labs, Derriford Hospital, Plymouth, United Kingdom; NHS-BT, Filton, United Kingdom
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32
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Deciphering IgM interference in IgG anti-HLA antibody detection with flow beads assays. Hum Immunol 2016; 77:1048-1054. [PMID: 26902993 DOI: 10.1016/j.humimm.2016.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/25/2016] [Accepted: 02/18/2016] [Indexed: 12/20/2022]
Abstract
In flow beads assays, the interference of IgM for IgG anti-HLA antibodies detection is not precisely understood. Using the screening flow beads assay for class I HLA antibodies, we analyzed the binding of two IgG mAbs, the anti-class I HLA W6/32 and an anti-beta-2-microglobulin, in the presence of an anti-beta-2-microglobulin IgM mAb. In neat serum, the IgM mAb impaired the detection of both IgG. In EDTA-treated serum, the interference was stronger for the anti-beta-2-microglobulin IgG than for W6/32, in agreement with the finding in surface plasmon resonance that this IgM competed with the anti-beta-2-microglobulin IgG but not with W6/32. The IgM interference was higher in neat than in EDTA-treated serum for both IgG mAbs. The IgM interference was also analyzed with class II single antigen flow beads and sera from two kidney recipients containing IgG and IgM donor specific antibodies. Anti-HLA IgG detection was partially corrected by EDTA, and restored by IgM inactivation with DTT, confirming the results observed with the mAbs. Therefore, three mechanisms can explain the IgM interference for IgG anti-HLA antibodies in flow beads assays: direct competition for antigen, steric hindrance and complement activation.
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33
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Berth M, Willaert S. Elimination of complement interference can improve the diagnostic performance of the VIDAS CMV IgG assay in acute cytomegalovirus infections. Diagn Microbiol Infect Dis 2016; 85:30-5. [PMID: 26971633 DOI: 10.1016/j.diagmicrobio.2016.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/25/2016] [Accepted: 02/02/2016] [Indexed: 12/24/2022]
Abstract
In this study we showed that complement factors are responsible for assay interference in the VIDAS cytomegalovirus (CMV) immunoglobulin G (IgG) assay. Three different serum treatments were applied to show the cause of interference: heat treatment (56 °C), adding cobra venom factor, and adding EDTA. Elimination of complement interference by EDTA treatment of serum was prospectively evaluated on 215 CMV IgM positive samples and a sensitivity increase of the VIDAS CMV IgG assay was noticed. On average the CMV IgG level increased 100% after EDTA treatment of the serum. In paired serum samples from 38 patients we could show that serum treatment with EDTA can make the CMV IgG level changes more obvious in recent CMV infections. Since the CMV IgG avidity II assay on VIDAS depends on the determination of CMV IgG, the CMV IgG avidity was also evaluated in this study but only a limited effect of the complement interference was observed.
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Affiliation(s)
- Mario Berth
- Algemeen Medisch Laboratorium (AML), Sonic Healthcare, Antwerpen, Belgium.
| | - Sofie Willaert
- Algemeen Medisch Laboratorium (AML), Sonic Healthcare, Antwerpen, Belgium
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34
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Loiseau P, Amokhrane K, Visentin J, Kheav VD, Caillat-Zucman S, Taupin JL. Use of Single-Antigen Flow Beads Assays to Assess Anti-HLA Donor-Specific Antibody Strength. Biol Blood Marrow Transplant 2016; 22:394-395. [DOI: 10.1016/j.bbmt.2015.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
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35
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Visentin J, Guidicelli G, Taupin JL. Assessing HLA Antibody Strength: Have We Thought About Everything? Am J Transplant 2015; 15:3271. [PMID: 26361370 DOI: 10.1111/ajt.13452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- J Visentin
- Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.,UMR CNRS 5164, Université de Bordeaux, Talence, France
| | - G Guidicelli
- Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - J-L Taupin
- Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.,UMR CNRS 5164, Université de Bordeaux, Talence, France
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36
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Neau-Cransac M, Le Bail B, Guidicelli G, Visentin J, Moreau K, Quinart A, Boueilh A, Laurent C, Taupin JL. Evolution of serum and intra-graft donor-specific anti-HLA antibodies in a patient with two consecutive liver transplantations. Transpl Immunol 2015; 33:58-62. [DOI: 10.1016/j.trim.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/07/2015] [Accepted: 08/17/2015] [Indexed: 01/30/2023]
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37
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Alheim M, Paul PK, Hauzenberger DM, Wikström AC. Improved flow cytometry based cytotoxicity and binding assay for clinical antibody HLA crossmatching. Hum Immunol 2015; 76:849-57. [PMID: 26429307 DOI: 10.1016/j.humimm.2015.09.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 09/02/2014] [Accepted: 09/28/2015] [Indexed: 11/29/2022]
Abstract
The presence of preformed donor-specific HLA antibodies leads to early antibody mediated kidney allograft rejection. Therefore, detection and avoidance of donor reactive HLA antibodies prior to transplantation is of outmost importance in order to minimize the risk of rejection. Detection of pre-formed HLA antibodies is currently performed using complement-dependent cytotoxicity (CDC) assay alone or together with a flow cytometry based crossmatch (FCXM). This study was initiated to further evaluate our recently developed flow cytometry based procedure for determination of both cytotoxicity of and IgG binding to donor-derived lymphocytes by HLA antibodies. Highly enriched immuno-magnetic bead purified T and B lymphocytes were used as target cells for patient sera using 96-well plates. Importantly, the assay shows high sensitivity and specificity as determined by HLA typed donor cells and serum with defined HLA antibody IgG and C1q. Based on this and additional data generated in this paper, such as evaluation of appropriate serum and complements incubation times and assay reproducibility and stability, will enable us to more rapidly implement this assay in our clinical laboratory routines. In addition, we demonstrate that FCtox crossmatching of deceased donor cells has superior specificity compared to conventional CDC assay especially regarding high frequencies of false-positive reactions.
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Affiliation(s)
- Mats Alheim
- Department of Laboratory Medicine, Division of Clinical Immunology and Transfusion Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
| | - Prashanta Kumer Paul
- Department of Laboratory Medicine, Division of Clinical Immunology and Transfusion Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Dan-Mikael Hauzenberger
- Department of Laboratory Medicine, Division of Clinical Immunology and Transfusion Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ann-Charlotte Wikström
- Department of Laboratory Medicine, Division of Clinical Immunology and Transfusion Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, SE-141 57 Stockholm, Sweden
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38
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Tambur AR, Herrera ND, Haarberg KMK, Cusick MF, Gordon RA, Leventhal JR, Friedewald JJ, Glotz D. Assessing Antibody Strength: Comparison of MFI, C1q, and Titer Information. Am J Transplant 2015; 15:2421-30. [PMID: 25930984 DOI: 10.1111/ajt.13295] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/09/2015] [Accepted: 02/28/2015] [Indexed: 02/06/2023]
Abstract
The presence of donor-specific HLA antibodies before or after transplantation may have different implications based on the antibody strength. Yet, current approaches do not provide information regarding the true antibody strength as defined by antigen-antibody dissociation rate. To assess currently available methods, we compared between neat mean fluorescence intensity (MFI) values, C1q MFI values, ethylenediaminetetraacetic acid (EDTA)-treated samples, as well as titration studies and peak MFI values of over 7000 Luminex-based single-antigen HLA antibody data points. Our results indicate that neat MFI values do not always accurately depict antibody strength. We further showed that EDTA treatment (6%) does not always remove all inhibitory factors compared with C1q or titration studies. In this study of patients presenting with multiple antibody specificities, a prozone effect was observed in 71% of the cohort (usually not affecting all antibody specificities within a single serum sample, though). Similar to titration studies, the C1q assay was able to address the issue of potential inhibition; however, its limitation is its low sensitivity and inability to detect the presence of weak antibodies. Titration studies are the only method among the approaches used in this study to provide information suggesting antigen-antibody dissociation rates and are, therefore, likely to provide better indication of true antibody strength.
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Affiliation(s)
- A R Tambur
- Transplant Immunology Laboratory, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - N D Herrera
- Transplant Immunology Laboratory, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - K M K Haarberg
- Transplant Immunology Laboratory, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - M F Cusick
- Transplant Immunology Laboratory, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - R A Gordon
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - J R Leventhal
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - J J Friedewald
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - D Glotz
- Nephrology and Transplantation Service, Hôpital Saint-Louis, Paris, France
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39
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Guidicelli G, Guerville F, Lepreux S, Wiebe C, Thaunat O, Dubois V, Visentin J, Bachelet T, Morelon E, Nickerson P, Merville P, Taupin JL, Couzi L. Non-Complement-Binding De Novo Donor-Specific Anti-HLA Antibodies and Kidney Allograft Survival. J Am Soc Nephrol 2015; 27:615-25. [PMID: 26047793 DOI: 10.1681/asn.2014040326] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/24/2015] [Indexed: 01/29/2023] Open
Abstract
C1q-binding ability may indicate the clinical relevance of de novo donor-specific anti-HLA antibodies (DSA). This study investigated the incidence and risk factors for the appearance of C1q-binding de novo DSA and their long-term impact. Using Luminex Single Antigen Flow Bead assays, 346 pretransplant nonsensitized kidney recipients were screened at 2 and 5 years after transplantation for de novo DSA, which was followed when positive by a C1q Luminex assay. At 2 and 5 years, 12 (3.5%) and eight (2.5%) patients, respectively, had C1q-binding de novo DSA. De novo DSA mean fluorescence intensity >6237 and >10,000 at 2 and 5 years, respectively, predicted C1q binding. HLA mismatches and cyclosporine A were independently associated with increased risk of C1q-binding de novo DSA. When de novo DSA were analyzed at 2 years, the 5-year death-censored graft survival was similar between patients with C1q-nonbinding de novo DSA and those without de novo DSA, but was lower for patients with C1q-binding de novo DSA (P=0.003). When de novo DSA were analyzed at 2 and 5 years, the 10-year death-censored graft survival was lower for patients with C1q-nonbinding de novo DSA detected at both 2 and 5 years (P<0.001) and for patients with C1q-binding de novo DSA (P=0.002) than for patients without de novo DSA. These results were partially confirmed in two validation cohorts. In conclusion, C1q-binding de novo DSA are associated with graft loss occurring quickly after their appearance. However, the long-term persistence of C1q-nonbinding de novo DSA could lead to lower graft survival.
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Affiliation(s)
- Gwendaline Guidicelli
- Departments of Immunology, Bordeaux University, Bordeaux, France; National Center for Scientific Research (CNRS), UMR 5164, Bordeaux, France
| | - Florent Guerville
- Bordeaux University, Bordeaux, France; National Center for Scientific Research (CNRS), UMR 5164, Bordeaux, France; Nephrology-Transplantation-Dialysis, and
| | - Sébastien Lepreux
- Bordeaux University, Bordeaux, France; Histopathology, Bordeaux University Hospital, Bordeaux, France
| | - Chris Wiebe
- Department of Medicine and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Olivier Thaunat
- Transplantation, Nephrology and Clinical Immunology Department, Lyon University Hospital, Lyon, France; National Institute for Health and Medical Research (INSERM) U1111, Lyon, France; Lyon Est Teaching and Research Unit, Lyon University, Lyon, France; and
| | - Valérie Dubois
- Histocompatibility Laboratory, French National Blood Service, Lyon, France
| | - Jonathan Visentin
- Departments of Immunology, Bordeaux University, Bordeaux, France; National Center for Scientific Research (CNRS), UMR 5164, Bordeaux, France
| | - Thomas Bachelet
- Bordeaux University, Bordeaux, France; National Center for Scientific Research (CNRS), UMR 5164, Bordeaux, France; Nephrology-Transplantation-Dialysis, and
| | - Emmanuel Morelon
- Transplantation, Nephrology and Clinical Immunology Department, Lyon University Hospital, Lyon, France; National Institute for Health and Medical Research (INSERM) U1111, Lyon, France; Lyon Est Teaching and Research Unit, Lyon University, Lyon, France; and
| | - Peter Nickerson
- Department of Medicine and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pierre Merville
- Bordeaux University, Bordeaux, France; National Center for Scientific Research (CNRS), UMR 5164, Bordeaux, France; Nephrology-Transplantation-Dialysis, and
| | - Jean-Luc Taupin
- Departments of Immunology, Bordeaux University, Bordeaux, France; National Center for Scientific Research (CNRS), UMR 5164, Bordeaux, France
| | - Lionel Couzi
- Bordeaux University, Bordeaux, France; National Center for Scientific Research (CNRS), UMR 5164, Bordeaux, France; Nephrology-Transplantation-Dialysis, and
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Pouliquen E, Koenig A, Chen CC, Sicard A, Rabeyrin M, Morelon E, Dubois V, Thaunat O. Recent advances in renal transplantation: antibody-mediated rejection takes center stage. F1000PRIME REPORTS 2015; 7:51. [PMID: 26097724 PMCID: PMC4447042 DOI: 10.12703/p7-51] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Overlooked for decades, antibodies have taken center stage in renal transplantation and are now widely recognized as the first cause of allograft failure. Diagnosis of antibody-mediated rejection has considerably improved with identification of antibody-mediated lesions in graft biopsies and advances made in the detection of circulating donor-specific antibodies. Unfortunately, this progress has not yet translated into better outcomes for patients. Indeed, in the absence of a drug able to suppress antibody generation by plasma cells, available therapies can only slow down graft destruction. This review provides an overview of the current knowledge of antibody-mediated rejection and discusses future interesting research directions.
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Affiliation(s)
- Eric Pouliquen
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Alice Koenig
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Chien Chia Chen
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Antoine Sicard
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Maud Rabeyrin
- Laboratoire d‘anatomopathologie, Hospices Civils de Lyon, Hôpital Edouard HerriotLyonFrance
| | - Emmanuel Morelon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Valérie Dubois
- Laboratoire d‘Histocompatibilité, Etablissement Français du SangLyonFrance
| | - Olivier Thaunat
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
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Basire A, Picard C. Stratégies d’exploration de l’allo-immunisation plaquettaire pour la prévention et la prise en charge des inefficacités transfusionnelles plaquettaires. Transfus Clin Biol 2014; 21:193-206. [DOI: 10.1016/j.tracli.2014.08.140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 08/28/2014] [Indexed: 12/12/2022]
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Lights and shadows of anti-HLA antibodies detected by solid-phase assay. Immunol Lett 2014; 162:181-7. [DOI: 10.1016/j.imlet.2014.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 08/09/2014] [Accepted: 08/21/2014] [Indexed: 11/21/2022]
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Deciphering Complement Interference in Anti–Human Leukocyte Antigen Antibody Detection With Flow Beads Assays. Transplantation 2014; 98:625-31. [DOI: 10.1097/tp.0000000000000315] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Focosi D, De Donno M, Pratesi F. Endogenous anti-C1q antibodies do not interfere with the C1qScreen™ assay. ACTA ACUST UNITED AC 2014; 83:356-7. [PMID: 24649862 DOI: 10.1111/tan.12339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 02/20/2014] [Indexed: 11/28/2022]
Affiliation(s)
- D Focosi
- Department of Translational Research, University of Pisa, Pisa, Italy
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Touzot M, Obada EN, Beaudreuil S, François H, Durrbach A. Complement modulation in solid-organ transplantation. Transplant Rev (Orlando) 2014; 28:119-25. [PMID: 24996770 DOI: 10.1016/j.trre.2014.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/08/2014] [Indexed: 01/18/2023]
Abstract
The complement system is a major constituent of the innate immune system. It has a critical role in defense against pathogens but dysregulation of complement activation may lead to tissue injury and modulate the adaptive immune response. In organ transplantation, local complement activation is involved in hyper-acute rejection and antibody-mediated rejection. This last decade, interest in complement activation has increased due to new insights into the pathophysiology of antibody-mediated rejection, but also since the availability of news drugs that target terminal complement activation. In this review, we discuss our current understanding of how local complement activation induces acute and chronic graft injury, and review recent advances in clinical trials that block complement activation using the anti-C5 monoclonal antibody, eculizumab. Finally, we discuss how complement-targeted therapy may be integrated into our current immunosuppressive regimen and what type of patient will benefit most from this therapy.
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Affiliation(s)
- Maxime Touzot
- Nephrology Department, IFRNT, Le Kremlin-Bicêtre, France; Institut National de la Santé et de la Recherche Médicale INSERM U1014, Villejuif, France
| | | | - Severine Beaudreuil
- Nephrology Department, IFRNT, Le Kremlin-Bicêtre, France; Institut National de la Santé et de la Recherche Médicale INSERM U1014, Villejuif, France
| | - Hélène François
- Nephrology Department, IFRNT, Le Kremlin-Bicêtre, France; Institut National de la Santé et de la Recherche Médicale INSERM U1014, Villejuif, France
| | - Antoine Durrbach
- Nephrology Department, IFRNT, Le Kremlin-Bicêtre, France; Institut National de la Santé et de la Recherche Médicale INSERM U1014, Villejuif, France.
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