Positive impact of DNA typing on solid organ transplantation

HLA-DR and DQ typing by polymerase chain reaction using sequence-specific primer mixes reduces the incidence of phenotypic homozygosity (blanks) over serology

Because of the inherent difficulties in allele assignment with HLA-DR serological typing, in 1993 our organ procurement organization-based HLA laboratory replaced serology with the molecular method of polymerase chain reaction using sequence-specific primer mixes (PCR-SSP) to type for DR and DQ at a resolution level equivalent to that of serologically defined antigens. In this study, we compared the incidence of DR blanks, where allocative homozygosity occurred, and graft outcome during our serology epoch (1987-1993) with that of our molecular epoch (1993-1996). The incidence of DR blanks by PCR-SSP (17.0%; 138/1101) was significantly lower (P<0.005) than in the serology epoch (21.5%; 569/2647). Although DQ is not a component of the allocation algorithm, the incidence of blanks in the molecular era (21.9%; 196/895) was 46% lower (P<0.001) than in the serology epoch (40.8%; 931/2277). Graft survival in 163 cadaveric renal transplant recipients for whom molecular DR allocation occurred (patient and donor were molecularly typed) showed that PCR-SSP typing had no significant effect on 2.5-year graft survival for patients mismatched for 0 (97%), 1 (90%), or 2 (94%) HLA-DR antigens (P=0.4; log-rank). In conclusion, molecular typing lowered the rate of DR and DQ blanks, but molecular matching for HLA DR and DQ did not influence graft outcome at 2.5 years.

Concepts, principles, and applications of selected molecular biology techniques in clinical biochemistry

The myriad molecular techniques that have been developed and are undergoing refinement have advanced our knowledge of disease processes and made available strategies for detection. While the greatest impact of molecular techniques in the diagnostic laboratory has been in the realm of infectious diseases, techniques such as flow cytometry, FISH, and multiplex-nested PCR followed by direct DNA sequencing are increasing the scope of cancer detection and treatment. The facile typing of HLA-class II genes is a major advance in the matching of donors to recipients of organ transplantation. With advances in genosensor technology and robotic automation, molecular biology techniques are clearly poised to enter the diagnostic clinical biochemistry laboratory for multiple applications.