1
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Jucaud V. Allogeneic HLA Humoral Immunogenicity and the Prediction of Donor-Specific HLA Antibody Development. Antibodies (Basel) 2024; 13:61. [PMID: 39189232 PMCID: PMC11348167 DOI: 10.3390/antib13030061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 08/28/2024] Open
Abstract
The development of de novo donor-specific HLA antibodies (dnDSAs) following solid organ transplantation is considered a major risk factor for poor long-term allograft outcomes. The prediction of dnDSA development is a boon to transplant recipients, yet the assessment of allo-HLA immunogenicity remains imprecise. Despite the recent technological advances, a comprehensive evaluation of allo-HLA immunogenicity, which includes both B and T cell allorecognition, is still warranted. Recent studies have proposed using mismatched HLA epitopes (antibody and T cell) as a prognostic biomarker for humoral alloimmunity. However, the identification of immunogenic HLA mismatches has not progressed despite significant improvements in the identification of permissible mismatches. Certainly, the prediction of dnDSA development may benefit permissible HLA mismatched organ transplantations, personalized immunosuppression, and clinical trial design. However, characteristics that go beyond the listing of mismatched HLA antibody epitopes and T cell epitopes, such as the generation of HLA T cell epitope repertoires, recipient's HLA class II phenotype, and immunosuppressive regiments, are required for the precise assessment of allo-HLA immunogenicity.
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Affiliation(s)
- Vadim Jucaud
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA 91367, 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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Laboux T, Lenain R, Visentin J, Flahaut G, Chamley P, Provôt F, Top I, Kerleau C, Labalette M, Choukroun G, Couzi L, Blancho G, Hazzan M, Maanaoui M. Impact of Preformed Donor-Specific Anti-HLA-Cw and Anti-HLA-DP Antibodies on Acute Antibody-Mediated Rejection in Kidney Transplantation. Transpl Int 2023; 36:11416. [PMID: 38076227 PMCID: PMC10698113 DOI: 10.3389/ti.2023.11416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/02/2023] [Indexed: 12/18/2023]
Abstract
Given the risk of rejection, the presence of preformed donor specific antibodies (DSA) contraindicates transplantation in most allocation systems. However, HLA-Cw and -DP DSA escape this censorship. We performed a multicentric observational study, in which the objective was to determinate risk factors of acute antibody-mediated rejection (aABMR) in recipients transplanted with preformed isolated Cw- or DP-DSA. Between 2010 and 2019, 183 patients were transplanted with a preformed isolated Cw- or DP-DSA (92 Cw-DSA; 91 DP-DSA). At 2 years, the incidence of aABMR was 12% in the Cw-DSA group, versus 28% in the DP-DSA group. Using multivariable Cox regression model, the presence of a preformed DP-DSA was associated with an increased risk of aABMR (HR = 2.32 [1.21-4.45 (p = 0.001)]) compared with Cw-DSA. We also observed a significant association between the DSA's MFI on the day of transplant and the risk of aABMR (HR = 1.09 [1.08-1.18], p = 0.032), whatever the DSA was. Interaction term analysis found an increased risk of aABMR in the DP-DSA group compared with Cw-DSA, but only for MFI below 3,000. These results may plead for taking these antibodies into account in the allocation algorithms, in the same way as other DSA.
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Affiliation(s)
- Timothée Laboux
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
- INSERM U1167, RID-AGE, University of Lille, Lille, France
| | - Rémi Lenain
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
- INSERM UMR 1246 – SPHERE, Nantes University, Tours University, Nantes, France
| | - Jonathan Visentin
- Department of Immunology and Immunogenetics, CHU Bordeaux, Bordeaux, France
- ImmunoConceEpT, CNRS UMR5164, Inserm ERL U1303, University of Bordeaux, Bordeaux, France
| | - Gauthier Flahaut
- Department of Nephrology, Internal Medicine, Dialysis and Transplantation, CHU Amiens, Jules Verne University of Picardie, Amiens, France
- EA7517, MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
| | - Paul Chamley
- Department of Nephrology, CH Roubaix, Roubaix, France
| | - François Provôt
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
| | - Isabelle Top
- Department of Immunology-HLA, CHU Lille, University of Lille, Lille, France
| | - Clarisse Kerleau
- CHU Nantes, Service de Néphrologie-Immunologie Clinique, ITUN, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Myriam Labalette
- Department of Immunology-HLA, CHU Lille, University of Lille, Lille, France
- INSERM UMR1286, INFINITE, University of Lille, Lille, France
| | - Gabriel Choukroun
- Department of Nephrology, Internal Medicine, Dialysis and Transplantation, CHU Amiens, Jules Verne University of Picardie, Amiens, France
- EA7517, MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
| | - Lionel Couzi
- ImmunoConceEpT, CNRS UMR5164, Inserm ERL U1303, University of Bordeaux, Bordeaux, France
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France
| | - Gilles Blancho
- CHU Nantes, Service de Néphrologie-Immunologie Clinique, ITUN, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Marc Hazzan
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
| | - Mehdi Maanaoui
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
- INSERM U1190, EGID, Institut Pasteur Lille, CHU Lille, University of Lille, Lille, France
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4
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Battle R, Pritchard D, Peacock S, Hastie C, Worthington J, Jordan S, McCaughlan JA, Barnardo M, Cope R, Collins C, Diaz-Burlinson N, Rosser C, Foster L, Kallon D, Shaw O, Briggs D, Turner D, Anand A, Akbarzad-Yousefi A, Sage D. BSHI and BTS UK guideline on the detection of alloantibodies in solid organ (and islet) transplantation. Int J Immunogenet 2023; 50 Suppl 2:3-63. [PMID: 37919251 DOI: 10.1111/iji.12641] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023]
Abstract
Solid organ transplantation represents the best (and in many cases only) treatment option for patients with end-stage organ failure. The effectiveness and functioning life of these transplants has improved each decade due to surgical and clinical advances, and accurate histocompatibility assessment. Patient exposure to alloantigen from another individual is a common occurrence and takes place through pregnancies, blood transfusions or previous transplantation. Such exposure to alloantigen's can lead to the formation of circulating alloreactive antibodies which can be deleterious to solid organ transplant outcome. The purpose of these guidelines is to update to the previous BSHI/BTS guidelines 2016 on the relevance, assessment, and management of alloantibodies within solid organ transplantation.
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Affiliation(s)
- Richard Battle
- Scottish National Blood Transfusion Service, Edinburgh, UK
| | | | - Sarah Peacock
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Sue Jordan
- National Blood Service Tooting, London, UK
| | | | - Martin Barnardo
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rebecca Cope
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | | - Luke Foster
- Birmingham Blood Donor Centre, Birmingham, UK
| | | | - Olivia Shaw
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - David Turner
- Scottish National Blood Transfusion Service, Edinburgh, UK
| | - Arthi Anand
- Imperial College Healthcare NHS Trust, London, UK
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5
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Knechtle S, Kwun J, Song S, Jackson A, Williams K, Sanoff S. Translation of therapeutic strategies to modulate B cell reponses from non-human primate models to human kidney transplantation. FRONTIERS IN TRANSPLANTATION 2023; 2:1176796. [PMID: 38993890 PMCID: PMC11235383 DOI: 10.3389/frtra.2023.1176796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/31/2023] [Indexed: 07/13/2024]
Abstract
Using novel drugs targeting lymphocyte costimulation, cytokines, antibody, complement, and plasma cells, we have developed strategies in a non-human primate model to modulate the B cell response to incompatible kidney transplants. After more than two decades of research supported by mechanistic studies, this has resulted in clinically relevant approaches that are currently enrolling in clinical trials or preparing for such. In this manner, we aim to address the problems of HLA sensitization for very highly sensitized patients awaiting transplantation and the unmet need of effective treatment for antibody-mediated rejection.
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Affiliation(s)
- Stuart Knechtle
- Duke Transplant Center, Duke University Medical Center, Durham, NC, United States
- Department of Surgery, Duke University, Durham, NC, United States
| | - Jean Kwun
- Duke Transplant Center, Duke University Medical Center, Durham, NC, United States
- Department of Surgery, Duke University, Durham, NC, United States
| | - Shengli Song
- Duke Transplant Center, Duke University Medical Center, Durham, NC, United States
- Department of Surgery, Duke University, Durham, NC, United States
| | - Annette Jackson
- Duke Transplant Center, Duke University Medical Center, Durham, NC, United States
- Department of Surgery, Duke University, Durham, NC, United States
| | - Kitza Williams
- Department of Surgery, Duke University, Durham, NC, United States
| | - Scott Sanoff
- Department of Medicine, Duke University Hospital, Durham NC, United States
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6
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Liwski RS, Tafulo S, Carroll R, Lan JH, Greenshields AL. Cutting through the weeds: Evaluation of a novel adsorption with crossmatch cells and elution protocol to sharpen HLA antibody identification by the single antigen bead assay. Front Genet 2022; 13:1059650. [PMID: 36531234 PMCID: PMC9748275 DOI: 10.3389/fgene.2022.1059650] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/18/2022] [Indexed: 10/01/2023] Open
Abstract
The single antigen bead (SAB) assay is the most used test for the identification of HLA specific antibodies pre- and post-transplant. Nevertheless, detection of spurious reactivities remains a recognized assay limitation. In addition, the presence of weak reactivity patterns can complicate unacceptable antigen assignment. This work presents the evaluation of the adsorption with crossmatch cells and elution (AXE) technique, which was designed to help differentiate weak HLA specific antibodies targeting native antigens from spurious and background SAB assay reactivity. The AXE protocol uses selected donor cells to adsorb HLA specific antibodies from sera of interest. Bound antibodies are then eluted off washed cells and identified using the SAB assay. Only antibodies targeting native HLA are adsorbed. Assay evaluation was performed using five cell donors and pooled positive control serum. AXE efficiency was determined by comparing SAB reactivity of adsorbed/eluted antibody to that of the antibodies in unadsorbed sera. A robust efficiency was seen across a wide range of original MFI for donor specific antibodies (DSA). A higher absorption/elution recovery was observed for HLA class I antigens vs. class II. Locus-specific variation was also observed, with high-expression HLA loci (HLA-A/B/DR) providing the best recovery. Importantly, negligible reactivity was detected in the last wash control, confirming that AXE eluates were not contaminated with HLA antibody carry-over. Donor cells incubated with autologous and DSA-containing allogeneic sera showed that AXE selectively adsorbed HLA antibodies in a donor antigen-specific manner. Importantly, antibodies targeting denatured epitopes or other non-HLA antigens were not detected by AXE. AXE was particularly effective at distinguishing weak HLA antibodies from background reactivity. When combined with epitope analysis, AXE enhanced precise identification of antibody-targeted eplets and even facilitated the characterization of a potential novel eplet. Comparison of AXE to flow cytometric crossmatching further revealed that AXE was a more sensitive technique in the detection of weak DSA. Spurious reactivities on the current SAB assay have a deleterious impact on the assignment of clinically relevant HLA specificities. The AXE protocol is a novel test that enables users to interrogate reactive patterns of interest and discriminate HLA specific antibodies from spurious reactivity.
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Affiliation(s)
- Robert S. Liwski
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sandra Tafulo
- Blood and Transplantation Center of Porto, Portuguese Institute for Blood and Transplantation, Porto, Portugal
| | - Robert Carroll
- Health and Medical Sciences, University of South Australia, Adelaide, SA, Australia
- Transplantation and Immunogenetics Service, Australian Red Cross Blood Services, Adelaide, SA, Australia
| | - James H. Lan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anna L. Greenshields
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS, Canada
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7
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Cashin J, Flynn P, Worthington J, Lowe M, Canterbury A, Launhardt K, Crosby I, Sheldon S, Venkateswaran R, Poulton K. An early evaluation of the HISTO SPOT ® AB ID Class I & II test in cardiothoracic transplant patients. Int J Immunogenet 2022; 49:317-324. [PMID: 35989448 DOI: 10.1111/iji.12595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/05/2022] [Accepted: 07/29/2022] [Indexed: 11/28/2022]
Abstract
The HISTO SPOT® AB ID assay (BAG Diagnostics GmbH) is a novel single antigen HLA Class I & II antibody definition test used with the MR.SPOT® processor. We compared this assay with Luminex® -based assays to assess its potential application in defining unacceptable antigens for transplantation in patients awaiting transplants with cardiothoracic organs. A cohort of 40 sensitized cardiothoracic patients were identified, and one sample was selected from each patient. The required screening was based on the patients' antibody profiles (Class I, n = 17, Class II, n = 11, Class I & II, n = 12). Samples were screened with LABScreen™ Single Antigen (SAg), LIFECODES® LSA™, HISTO SPOT® AB ID, and an acid modified LABScreen™ SAg test for detecting antibodies against denatured HLA. Results indicated that HISTO SPOT® AB ID had reduced sensitivity (68% for Class I; 69% for Class II). When compared to LABScreen™ and LIFECODES® , HISTO SPOT® AB ID failed to detect Luminex® -defined antibodies with median fluorescence intensity (MFI) ranging from 1114 to 24,489. The HISTO SPOT® AB ID panel used in the study had reduced antigen representation compared with Luminex® -based assays which further compromised its capacity for antibody detection and definition. Further work is needed to evaluate the clinical relevance of these differences between the performance of HISTO SPOT® and Luminex® -based methods.
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Affiliation(s)
- James Cashin
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester, UK
| | - Patrick Flynn
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester, UK
| | | | - Marcus Lowe
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester, UK
| | | | | | | | - Stephen Sheldon
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester, UK
| | - Rajamiyer Venkateswaran
- University Hospital of South Manchester Transplant Unit, Wythenshawe Hospital, Manchester, UK
| | - Kay Poulton
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester, UK
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8
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Battle RK, Rennie TJW, Phelan PJ, Abel AA, McConnell S, Turner DM. Highly sensitised patients awaiting deceased donor renal transplants are disadvantaged by the presence of denatured HLA antibody detected in routine HLA antibody testing. HLA 2022; 100:24-36. [PMID: 35150076 DOI: 10.1111/tan.14578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/20/2022] [Accepted: 02/09/2022] [Indexed: 11/27/2022]
Abstract
Luminex Single Antigen Bead (SAB) assays used to detect HLA antibodies may artificially increase sensitisation in highly sensitised patients. The presence of denatured HLA (dHLA) within the assay enables antibodies specific to cryptic HLA epitopes to bind, such antibodies are not clinically relevant. We sought to exclude dHLA reactivity in a cohort of very highly sensitised patients (HSP), calculated reaction frequency (cRF) 95-100%, and determine the effect upon sensitisation. Such patients have limited access to suitable donors and small changes in their HLA antibody profile, particularly where their cRF is 100%, can increase their opportunity of a transplant. We determined the presence of dHLA by aligning antibody reactivity which did not correspond to known HLA class I epitope mismatches with the results of assays modified to detect class I dHLA. 130 class I dHLA reactions were identified within 11 HSP, all of whom had clear sensitising events. cRF was corrected for dHLA, mean cRF 98.2% (93-100) pre and 95.5% (87-100) post correction (P = 0.0156). An increase in the number of predicted compatible donors (p = 0.0078) after dHLA correction was demonstrated. Two manufacturers SAB assays were used. A reduction of patients with 100% cRF was observed for both manufactures. dHLA is contributing to sensitisation in HSP and is detrimental to their chances of receiving a compatible transplant. The observed dHLA reactivity varied according to kit manufacturers (P = 0.0001), this is potentially a useful finding for laboratories wishing to discriminate between nHLA and dHLA, but without the resources required to regularly perform dHLA assay and epitope analyses. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Richard K Battle
- Scottish National Blood Transfusion Service, Royal Infirmary Edinburgh, United States
| | | | - Paul J Phelan
- Department of Renal Medicine, Royal Infirmary of Edinburgh, United States
| | - Angela A Abel
- Scottish National Blood Transfusion Service, Royal Infirmary Edinburgh, United States
| | - Sylvia McConnell
- Scottish National Blood Transfusion Service, Royal Infirmary Edinburgh, United States
| | - David M Turner
- Scottish National Blood Transfusion Service, Royal Infirmary Edinburgh, United States
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9
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Xu Q, Sood P, Helmick D, Lomago JS, Tevar AD, Zeevi A. Positive flow cytometry crossmatch with discrepant antibody testing results following COVID-19 vaccination. Am J Transplant 2021; 21:3785-3789. [PMID: 34241963 PMCID: PMC8441686 DOI: 10.1111/ajt.16753] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 01/25/2023]
Abstract
The impact of COVID-19 vaccination on the alloimmunity of transplant candidates is unknown. We report a case of positive B cell flow cytometry crossmatch in a patient waiting for second kidney transplantation, 37 days after receiving the COVID-19 vaccine. The preliminary crossmatch, using sample collected before COVID-19 vaccination, was negative. The antibodies to mismatched donor HLA-DR7 were detected only with multi-antigen beads but not with single-antigen beads, excluding possible prozone effects in solid-phase antibody assays. The crossmatches were positive with HLA-DR7-positive surrogates (n = 2) while negative with HLA-DR7-negative surrogates (n = 3), which confirms the HLA-DR7 alloreactivity. The antigen configurations on B lymphocytes are similar to that on the multi-antigen beads while distinct from the single-antigen beads. HLA-DR7 was the repeating mismatched antigen with the failing first kidney allograft. The newly emerged antibody to HLA-DR7 probably is the consequence of bystander activation of memory response by the COVID-19 vaccination. This case highlights the importance of verifying allo-sensitization history and utilizing multiple assays, including cell-based crossmatch and solid-phase assays with multi-antigens. COVID-19 immunization may deserve special attention when assessing the immunological risk before and after organ transplantation.
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Affiliation(s)
- Qingyong Xu
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA,Correspondence Qingyong Xu, Department of Pathology, University of Pittsburgh Medical Center, UPMC-Clinical Lab Building, Pittsburgh, PA, USA.
| | - Puneet Sood
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dennis Helmick
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jon S. Lomago
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amit D. Tevar
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA,Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Adriana Zeevi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA,Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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10
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Karahan GE, de Vaal Y, Bakker K, Roelen D, Claas FHJ, Heidt S. Comparison of different luminex single antigen bead kits for memory B cell-derived HLA antibody detection. HLA 2021; 98:200-206. [PMID: 34216435 PMCID: PMC8456970 DOI: 10.1111/tan.14356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/17/2021] [Accepted: 06/29/2021] [Indexed: 12/02/2022]
Abstract
Detection of HLA‐specific memory B cells can provide additional information on sensitization of alloantigen‐exposed individuals and refine immunological risk assessment. We have recently developed an assay enabling profiling of memory B cell‐derived HLA antibodies using luminex single antigen bead (SAB) assay. Here, we compared the performance of the SAB kits from two vendors for memory B cell‐derived HLA antibody detection. IgG was isolated from culture supernatants of polyclonally activated B cells from alloantigen‐exposed (n = 7) or nonexposed (n = 5) individuals, using our previously established method. Eluates containing isolated IgG from culture supernatants were tested for the presence of HLA antibodies using luminex SAB analysis from both One Lambda and Lifecodes (Immucor). In contrast to Lifecodes, high mean fluorescence intensity (MFI) signals were found for negative control beads in One Lambda (median MFI for class I:1730 and for class II:728), accompanied by high MFI values for self HLA‐coated beads, especially for HLA‐C. Despite high background in the One Lambda assays, 91% concordance for HLA class I and 85% concordance for HLA class II were found between the specificities detected using SAB kits from the two vendors. Our results show that HLA‐specific memory B cells can be profiled using kits from both vendors. However, when analyzing One Lambda results one should be aware of the restrictions related to nonspecific binding particularly in HLA‐C‐coated beads, and pay attention to self HLA‐coated beads in order to accurately identify the reactivities leading to the definition of the actual HLA antibody specificities.
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Affiliation(s)
- Gonca E Karahan
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne de Vaal
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kim Bakker
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dave Roelen
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frans H J Claas
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sebastiaan Heidt
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Song S, Manook M, Kwun J, Jackson AM, Knechtle SJ, Kelsoe G. Allo-Specific Humoral Responses: New Methods for Screening Donor-Specific Antibody and Characterization of HLA-Specific Memory B Cells. Front Immunol 2021; 12:705140. [PMID: 34326847 PMCID: PMC8313870 DOI: 10.3389/fimmu.2021.705140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/22/2021] [Indexed: 12/28/2022] Open
Abstract
Antibody-mediated allograft rejection (AMR) causes more kidney transplant failure than any other single cause. AMR is mediated by antibodies recognizing antigens expressed by the graft, and antibodies generated against major histocompatibility complex (MHC) mismatches are especially problematic. Most research directed towards the management of clinical AMR has focused on identifying and characterizing circulating donor-specific HLA antibody (DSA) and optimizing therapies that reduce B-cell activation and/or block antibody secretion by inhibiting plasmacyte survival. Here we describe a novel set of reagents and techniques to allow more specific measurements of MHC sensitization across different animal transplant models. Additionally, we have used these approaches to isolate and clone individual HLA-specific B cells from patients sensitized by pregnancy or transplantation. We have identified and characterized the phenotypes of individual HLA-specific B cells, determined the V(D)J rearrangements of their paired H and L chains, and generated recombinant antibodies to determine affinity and specificity. Knowledge of the BCR genes of individual HLA-specific B cells will allow identification of clonally related B cells by high-throughput sequence analysis of peripheral blood mononuclear cells and permit us to re-construct the origins of HLA-specific B cells and follow their somatic evolution by mutation and selection.
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Affiliation(s)
- Shengli Song
- Department of Immunology, Duke University School of Medicine, Durham, NC, United States
| | - Miriam Manook
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Jean Kwun
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Annette M. Jackson
- Department of Immunology, Duke University School of Medicine, Durham, NC, United States
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Stuart J. Knechtle
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Garnett Kelsoe
- Department of Immunology, Duke University School of Medicine, Durham, NC, United States
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States
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12
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Shimabukuro S, Iwasaki K, Kawai S, Shirouzu T, Miwa Y, Iida Y, Nakajima F, Horimi K, Matsuoka Y, Ashimine S, Ishiyama K, Kobayashi T. Improved detection of donor-specific HLA-class II antibody in kidney transplant recipients by modified immunocomplex capture fluorescence analysis. Transpl Immunol 2021; 67:101418. [PMID: 34052300 DOI: 10.1016/j.trim.2021.101418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022]
Abstract
Immunocomplex capture fluorescence analysis (ICFA) which basic principle is same as Luminex crossmatch (LXM), could detect donor-specific HLA antibody (DSA). The advantages of ICFA are (i) detection of DSA and (ii) no requirement of viable cells over the flow cytometry crossmatch (FCXM). However, FCXM has been widely used because of its higher sensitivity than ICFA, in particular HLA-class II antibody detection. In this study the accuracy of DSA detection against HLA-class II was investigated by modifying the original method of ICFA. Increment of the sensitivity was found when purified peripheral blood mononuclear cells (PBMCs) were used instead of whole blood. An ICFA-PBMC in addition to FCXM-T/B was conducted for 118 patients before kidney transplantation and 13 patients with de novo DSA against HLA-class II after transplantation. Significantly positive correlation was observed between the values of ICFA-PBMC and DSA mean fluorescence intensity (MFI) targeting class II (p < 0.0001). When the cutoff level of 1.4 was determined by receiver operating characteristic curve analysis, the average DSA MFI was found to be significantly higher in the ICFA-PBMC (class II) positive group comparing to that in the negative group (12,217 vs 3885, p = 0.0027). ICFA-PBMC and optimized cutoff level could provide valid information in cases of suspected DSA.
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Affiliation(s)
- Shuichi Shimabukuro
- Department of Urology, Okinawa Chubu Hospital, 281, Miyazato, Uruma, Okinawa, Japan; Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kenta Iwasaki
- Department of Kidney Disease and Transplant Immunology, Aichi Medical University School of Medicine, Nagakute, Japan.
| | - Shintaro Kawai
- Wakunaga Pharmaceutical Co, Ltd, Molecular Diagnostics Division, Osaka, Japan
| | - Takayuki Shirouzu
- Wakunaga Pharmaceutical Co, Ltd, Molecular Diagnostics Division, Osaka, Japan
| | - Yuko Miwa
- Department of Kidney Disease and Transplant Immunology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yusuke Iida
- Department of Kidney Disease and Transplant Immunology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Fumiaki Nakajima
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Kosei Horimi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yutaka Matsuoka
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Satoshi Ashimine
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kohei Ishiyama
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
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13
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Bestard O, Couzi L, Crespo M, Kessaris N, Thaunat O. Stratifying the humoral risk of candidates to a solid organ transplantation: a proposal of the ENGAGE working group. Transpl Int 2021; 34:1005-1018. [PMID: 33786891 DOI: 10.1111/tri.13874] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/26/2021] [Indexed: 12/30/2022]
Abstract
Detection of circulating antibodies directed against human leukocyte antigen (HLA) molecules, which corresponds to the current definition of 'sensitized patient', has been shown to have a severe impact on both access to transplantation and, if the anti-HLA antibodies are specific to the selected donor, survival of the graft. However, not all donor-specific antibodies (DSA) are equally harmful to the graft and progress in the understanding of humoral memory has led to the conclusion that absence of DSA at transplantation does not rule out the possibility that the patient has a preformed cellular humoral memory against the graft (thereby defining a category of DSA-negative sensitized recipients). Technological progress has led to the generation of new assays that offer unprecedented precision in exploring the different layers (serological and cellular) of alloimmune humoral memory. Based on this recent knowledge, the EuropeaN Guidelines for the mAnagement of Graft rEcipients (ENGAGE) working group to propose an updated definition of sensitization in candidates for solid organ transplantation - one that moves away from the current binary division towards a definition based on homogenous strata with similar humoral risk.
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Affiliation(s)
- Oriol Bestard
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain.,Bellvitge Research Institute (IDIBELL), Barcelona, Spain
| | - Lionel Couzi
- Nephrology-Transplantation-Dialysis, CHU Bordeaux, Bordeaux, France.,CNRS-UMR 5164 Immuno ConcEpT, Bordeaux University, Bordeaux, France
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain.,Nephropathies Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Nicos Kessaris
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,King's College London, London, UK
| | - Olivier Thaunat
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France.,Université Claude-Bernard Lyon I, Lyon, France.,Institut National de la Santé et de la Recherche Médicale U1111, Lyon, France
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14
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Usureau C, Lefèvre E, Top I, Nikolski M, Varlet P, Choukroun G, Desoutter J, Guillaume N. Antibodies against HLA cross-reactivity groups: From single antigen bead assay to immunoinformatics interpretation of epitopes. Mol Immunol 2021; 133:154-162. [PMID: 33667985 DOI: 10.1016/j.molimm.2021.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 01/26/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
Identification of anti-human leukocyte antigen (HLA) antibodies (Abs) is based on Luminex™ technology. We used bioinformatics to (i) study the correlations of mean fluorescence intensities (MFIs) for all the possible allele pairs, and (ii) determine the degree of epitope homology between HLA antigens. Using MFI data on anti-HLA Abs from 6000 Luminex™ assays, we provide an updated overview of class I and II HLA antigen cross-reactivity in which each node corresponded to an allele and each link corresponded to a strong correlation between two alleles (Spearman's ρ > 0.8). We compared these correlations with the serological groups and the results of an epitope analysis. The strongest correlations concerned allele-specific Abs directed against the same antigen. For the HLA-A locus, the highest values of Spearman's ρ reflected broad specificity. For the HLA-B locus, graphs defined the HLA-Bw4 public epitope, and correlations between HLA-A and -B alleles were only present for beads with the same Bw4 public epitope. For the HLA-C locus, we identified two groups that differed with regard to their KIR ligand subclassification. Lastly, the HLA-DRB1 subgroups were part of a network. In the epitope analysis, Spearman's ρ was related to the number of matched epitopes within pairs of alleles. The combination of Spearman's ρ with simple, undirected graphing constitutes an effective tool for understanding routinely encountered cross-reactivity profiles. Based on this model, we have implemented an online data visualization tool available at http://cusureau.pythonanywhere.com/.
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Affiliation(s)
- Cédric Usureau
- Department of Hematology and Histocompatibility, Amiens University Medical Center, Amiens, France; EA 4666 Hematim, Jules Verne University of Picardie, Amiens, France; French Speaking Society of Histocompatibility and Immunogenetic (SFHI), France
| | - Edgar Lefèvre
- Bordeaux Bioinformatics Center, CNRS, IBGC CNRS UMR 5095, Bordeaux University, Bordeaux, France
| | - Isabelle Top
- French Speaking Society of Histocompatibility and Immunogenetic (SFHI), France; Department of Immunology and Histocompatibility, Lille University Hospital, Lille, France
| | - Macha Nikolski
- Bordeaux Bioinformatics Center, CNRS, IBGC CNRS UMR 5095, Bordeaux University, Bordeaux, France
| | - Pauline Varlet
- French Speaking Society of Histocompatibility and Immunogenetic (SFHI), France; Department of Immunology and Histocompatibility, Lille University Hospital, Lille, France
| | - Gabriel Choukroun
- Department of Nephrology and Transplantation, Amiens University Hospital, Amiens, France
| | - Judith Desoutter
- Department of Hematology and Histocompatibility, Amiens University Medical Center, Amiens, France; EA 4666 Hematim, Jules Verne University of Picardie, Amiens, France; French Speaking Society of Histocompatibility and Immunogenetic (SFHI), France
| | - Nicolas Guillaume
- Department of Hematology and Histocompatibility, Amiens University Medical Center, Amiens, France; EA 4666 Hematim, Jules Verne University of Picardie, Amiens, France; French Speaking Society of Histocompatibility and Immunogenetic (SFHI), France.
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15
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Eplet-based virtual PRA increases transplant probability in highly-sensitized patients. Transpl Immunol 2021; 65:101362. [PMID: 33434652 DOI: 10.1016/j.trim.2021.101362] [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: 09/08/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The reduced access of highly-sensitized (HS) patients to kidney transplantation (KTx) is one of the major challenges for transplant community. Therefore, the aim of our study was to estimate the impact of three different vPRA calculations, assessed traditionally and using eplet-based analysis, in donor offers. METHODS At 01-01-2020, 157 HS patients are waitlisted for deceased donor KTx and were included in this study. Total vPRA (vPRAt) was calculated considering all patient allosensitization history, using 1 k MFI cut-off. Current vPRA (vPRAc) refers only to the last year SAB assays, using 1 k MFI cut-off. For eplet vPRA (vPRAe) every SAB assay was analyzed by HLAMatchmaker and HLAfusion software. Matching runs have been performed taking vPRA calculation as unacceptable antigens (UAs). RESULTS All patients had at least one previous sensitizing event and patients with 100% vPRA were predominantly candidates for retransplantation (P < 0.001), had higher PRA-CDC (P < 0.001), and longer dialysis vintage waiting time (P < 0.001). Inter-group movement analysis between vPRA measures showed that 70 (45%), 124 (79%) and 80 (51%) patients were reclassified to a lower group when considering vPRAt to vPRAc, vPRAt to vPRAe and vPRAc to vPRAe, respectively. The median percentage of change in estimated number of match runs needed for 95% probability of finding an acceptable donor was significantly more pronounced by increasing vPRAt intervals, when considering the reclassification from vPRAt to vPRAe (P < 0.001) or vPRAc to vPRAe (P = 0.045), while from vPRAt to vPRAc it was not (P = 0.899). CONCLUSIONS Our study demonstrated that the use of total or current vPRA calculations are impairing HS patients, by decreasing transplant probability, leading to dramatically longer waiting times, when compared to eplet based vPRA.
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16
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Park BG, Park Y, Kim BS, Kim YS, Kim HS. False Positive Class II HLA Antibody Reaction Due to Antibodies Against Denatured HLA Might Differ Between Assays: One Lambda vs. Immucor. Ann Lab Med 2021; 40:424-427. [PMID: 32311858 PMCID: PMC7169623 DOI: 10.3343/alm.2020.40.5.424] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/03/2020] [Accepted: 03/13/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Borae G Park
- Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Younhee Park
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Beom Seok Kim
- Department of Nephrology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yu-Seun Kim
- Department of Transplant Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyon-Suk Kim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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17
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Sullivan HC, Krummey SM, Gebel HM, Bray RA. The utility of second single antigen bead assay: Clearing the water or stirring up mud? Hum Immunol 2020; 81:663-670. [PMID: 33036787 PMCID: PMC8336427 DOI: 10.1016/j.humimm.2020.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/25/2020] [Accepted: 09/24/2020] [Indexed: 12/01/2022]
Abstract
Though solid-phase single antigen bead (SAB) testing has provided major advances to the HLA community and organ allocation, it has not been without limitations. In particular, false-positive reactions lead to interpretative challenges and the potential to preclude a transplant if the corresponding antigens are deemed unacceptable. Two different vendor platforms are commercially available for SAB testing, one more recent than the other. The aim herein was to assess the benefit of using the newer SAB platform in situations where the primary platform yielded suspicious (specifically, false positive) reactions. Therefore, 42 serum samples with commonly encountered false-positive patterns observed in our laboratory were tested with the newer platform. Cases were classified as resolved, equivalent, or divergent based on whether the second platform produced no reactivity, the same pattern, or a distinctly different pattern compared to the primary platform, respectively. Approximately 33% of cases were resolved, 46% were equivalent, and 21% were divergent. The project revealed advantages of adding a second SAB platform to the laboratory's test menu including resolving challenging samples and including broader coverage of different alleles and unique class II alpha/beta subunit combinations. However, the challenges of validating, maintaining, and billing for another test method in the laboratory may be barriers to routine use.
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Affiliation(s)
- Harold C Sullivan
- Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA.
| | - Scott M Krummey
- Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
| | - Howard M Gebel
- Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
| | - Robert A Bray
- Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
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18
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Gutiérrez-Larrañaga M, Riesco L, Guiral S, Irure J, Rodrigo E, Ocejo-Vinyals J, Martorell J, Caro JL, López-Hoyos M, San Segundo D. Detection of antibodies to denatured human leucocyte antigen molecules by single antigen Luminex. HLA 2020; 97:52-59. [PMID: 33040479 DOI: 10.1111/tan.14098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/04/2020] [Accepted: 10/04/2020] [Indexed: 12/26/2022]
Abstract
The anti-HLA antibody detection has been improved in sensitivity and specificity with solid-phase antigen bead (SAB) assays based on Luminex. However, false positive results due to denatured HLA (dHLA) may arise after single antigen test. The aim of this study was to compare the performance of the two Luminex technology-based anti-HLA detection kits available in the market in showing undesired anti-HLA antibody results. A prospective cohort was assessed for anti-HLA antibodies with single antigen A manufacturer (AM) kit and a comparison cohort with single antigen B manufacturer (BM) kit. A total of 11 out of 90 patients in a prospective cohort presented monospecific HLA-I antibodies with AM, and 5 out of 11 confirmed monospecific reaction with BM. Despite the confirmation of monospecific reaction with both manufacturers, 80% were assigned as dHLA reaction by specific crossmatch. Further comparative cohorts detected four out of six monospecific reactions with BM that were confirmed as possible dHLA reactions. A positive SAB test should rule out a reaction against a dHLA molecule, thus avoidance of prolonged waitlist periods or misattribution of anti-HLA reactions after transplantation.
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Affiliation(s)
- María Gutiérrez-Larrañaga
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Laura Riesco
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Sandra Guiral
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Juan Irure
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Emilio Rodrigo
- Nephrology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Javier Ocejo-Vinyals
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | | | - Jose L Caro
- Immunology Department, Hospital Clínic, Barcelona, Spain
| | - Marcos López-Hoyos
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - David San Segundo
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
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19
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Visentin J, Couzi L, Taupin JL. Clinical relevance of donor-specific antibodies directed at HLA-C: A long road to acceptance. HLA 2020; 97:3-14. [PMID: 33052032 DOI: 10.1111/tan.14106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 12/21/2022]
Abstract
In solid organ transplantation (SOT), the clinical relevance of donor-specific antibodies (DSA) directed at anti-HLA-A, -B, -DR and -DQ antigens is largely recognized while it is still a matter of debate for DSA directed at HLA-C. In this review, we summarize the peculiarities of HLA-C among class I HLA antigens as well as their immunogenicity, which underlie the clinical relevance of HLA-C locus and anti-HLA-C DSA in SOT. Many factors, both intrinsic and extrinsic to the HLA-C gene and HLA-C protein, explain its lower expression in comparison with HLA-A and -B. This lower expression can explain the apparent lower immunogenicity of HLA-C leading to a lower prevalence and strength of anti-HLA-C antibodies. Nevertheless, HLA-C antigens are truly immunogenic and preformed anti-HLA-C DSA are clinically relevant. Indeed, anti-HLA-C DSA are able to bind donor cells and to activate the complement pathway both ex vivo and in vivo. In line with this, numerous clinical studies now show that preformed DSA directed at native HLA-C molecules induce poorer graft outcomes. We then plead for the inclusion of HLA-C in all transplant allocation systems and we propose a strategy to cope with anti-HLA-C DSA in SOT. Beyond SOT, anti-HLA-C antibodies generate a growing interest in the allo-HCT, transfusion and obstetrics fields, while new concepts such as the role of the "missing-self" in solid organ rejection places HLA-C as an inescapable actor in transplant tolerance.
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Affiliation(s)
- Jonathan Visentin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France.,University of Bordeaux, CNRS, ImmunoConcEpT, Bordeaux, France
| | - Lionel Couzi
- University of Bordeaux, CNRS, ImmunoConcEpT, Bordeaux, France.,CHU de Bordeaux, Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France
| | - Jean-Luc Taupin
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, Paris, France.,INSERM, UMR976, and Institut de Recherche saint-Louis, Université de Paris, Paris, France
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20
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Bonnet M, Visentin J, Caillat-Zucman S, Jollet I, Taupin JL. Monoclonal secondary reagents do not outperform polyclonal secondary reagents for detection of anti-HLA IgG using single antigen flow beads assays. HLA 2020; 96:456-467. [PMID: 32530111 DOI: 10.1111/tan.13972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/12/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
Abstract
Luminex single antigen flow beads (SAFB) assays are used to monitor anti-HLA antibodies, which are associated with allograft loss. The primary antibody binding level is evaluated by the mean fluorescence intensity (MFI) provided by the tracing secondary antibody. The aim of this study was to compare the MFI obtained with two secondary antibodies and to evaluate their sensitivity to detect newly developed de novo anti-HLA donor-specific antibodies (dnDSA). A total of 23 and 46 different sera from 20 HLA-sensitized kidney transplant recipients were tested with class I and II SAFB, respectively, as well as sera from 17 patients with dnDSA. The conventional secondary antibody (IgHPolyFab) was the phycoerythrin (PE)-conjugated goat anti-human IgG constant heavy chain (HC)-binding polyclonal-F(ab')2. The alternate secondary antibody was a PE-conjugated anti-human IgG Fc-specific monoclonal IgG (FcMonoIgG). MFI of negative control sera were drastically lower with the FcMonoIgG than with IgHPolyFab, requesting a unique positivity threshold to be defined for each secondary antibody. MFI obtained with positive control sera were also lower with FcMonoIgG. In kidney transplant recipient's sera, the number of antigenic specificities detected by each secondary antibody was comparable, for dnDSA as well as for nonDSA. In conclusion, decision thresholds must be refined when changing the secondary tracing reagent in SAFB assays. FcMonoIgG did not demonstrate any superiority over IgHPolyFab for monitoring HLA antibodies.
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Affiliation(s)
- Marie Bonnet
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, Paris, France
| | - Jonathan Visentin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, Bordeaux, France.,ImmunoConcEpT, Bordeaux, France
| | - Sophie Caillat-Zucman
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, Paris, France.,INSERM UMR976, Université Paris Diderot, Paris, France
| | - Isabelle Jollet
- Etablissement Français du Sang Centre-Atlantique, Poitiers, France
| | - Jean-Luc Taupin
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, Paris, France.,INSERM UMR976, Université Paris Diderot, Paris, France
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21
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Snanoudj R, Siemowski J, Amankwa E, Kheav VD, Arzouk N, Galichon P, Matignon M, Legendre C, Delahousse M, Caillat-Zucman S, Taupin JL. Predictive value of mixed antigen screen beads in pre-transplant assessment of HLA immunization in solid organ transplant recipients. Clin Transplant 2020; 34:e14002. [PMID: 32510715 DOI: 10.1111/ctr.14002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/02/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022]
Abstract
Pre-transplant serum screening of anti-HLA antibodies is recommended for solid organ transplantations. Many laboratories use the less expensive bead-based screening assay as the main technique and, if positive, turn to single-antigen beads (SAB). We studied the correlations between these two immunoassays. We re-analyzed the raw data of the two assays in 3030 first organ transplant recipients, explored with the two tests. We performed a ROC curve analysis of the screening ratio to predict a positive SAB assay. The AUC were 0.72 and 0.64 for class I and class II. The optimal thresholds of screening ratios were 3.28 (class I) and 2.11 (class II). Whatever the class, the negative predictive value was low, around 40%, with 36% of discordant sera, as defined by negative screening and positive SAB. Testing class I discordant sera on acid-treated SAB showed that 54% of antibodies reacted against denatured HLA molecules. However, these screening-negative sera may contain donor-specific antibodies in 13.9% and 28.7% of cases for class I and class II, respectively, involved in antibody-mediated rejection with the same frequency as non-discordant sera. Given the low predictive value of screening, both assays should be performed at least once on the same serum before transplantation.
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Affiliation(s)
- Renaud Snanoudj
- Transplantation and Nephrology Department, Hôpital Foch, Suresnes, France
| | - Jérémy Siemowski
- Laboratory of Immunology and Histocompatibility, Hôpital Saint-Louis, Paris, France
| | - Elizabeth Amankwa
- Laboratory of Immunology and Histocompatibility, Hôpital Saint-Louis, Paris, France
| | - Vissal-David Kheav
- Laboratory of Immunology and Histocompatibility, Hôpital Saint-Louis, Paris, France
| | - Nadia Arzouk
- Transplantation and Nephrology Department, Hôpital Pitié-Salpétrière, Paris, France
| | - Pierre Galichon
- Transplantation and Nephrology Department, Hôpital Pitié-Salpétrière, Paris, France
| | - Marie Matignon
- Transplantation and Nephrology Department, Hôpital Henri-Mondor, Créteil, France
| | | | - Michel Delahousse
- Transplantation and Nephrology Department, Hôpital Foch, Suresnes, France
| | - Sophie Caillat-Zucman
- Laboratory of Immunology and Histocompatibility, Hôpital Saint-Louis, Paris, France.,INSERM UMRS 976, Institut Universitaire d'Hématologie, University Paris Diderot, Hôpital Saint-Louis, Paris, France
| | - Jean-Luc Taupin
- Laboratory of Immunology and Histocompatibility, Hôpital Saint-Louis, Paris, France
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22
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Little AM. HLA antibodies in haematopoietic stem cell transplantation. HLA 2020; 94 Suppl 2:21-24. [PMID: 31674146 DOI: 10.1111/tan.13741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/01/2019] [Accepted: 10/30/2019] [Indexed: 11/28/2022]
Abstract
The negative impact of donor specific HLA alloantibodies in solid organ transplantation is well known and understood within the histocompatibility and immunogenetics community. However the influence of donor-specific antibodies in the outcome of haematopoietic stem cell transplantation is less well regarded. As donor choices have evolved from HLA matched siblings and extremely well matched unrelated donors to mismatched cord blood and haplo-identical-related donors, we are now identifying more patients with antibodies reactive against their donor mismatches. The clinical significance of the antibodies that can be detected has not yet been fully elucidated.
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Affiliation(s)
- Ann-Margaret Little
- Histocompatibility and Immunogenetics Laboratory, Gartnavel General Hospital, Glasgow, UK.,Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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23
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Battle RK, Henderson L, Phelan PJ, Latham K, Turner DM. A case report—Two manufacturers
SAB
testing kits can reveal different
HLA
antibody profiles—Identifying prozone and denatured antigen. HLA 2020; 96:76-82. [DOI: 10.1111/tan.13913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/19/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Richard K. Battle
- Histocompatibility and Immunogenetics DepartmentScottish National Blood Transfusion Service Edinburgh UK
| | - Lorna Henderson
- Department of Renal MedicineRoyal Infirmary of Edinburgh Edinburgh UK
| | - Paul J. Phelan
- Department of Renal MedicineRoyal Infirmary of Edinburgh Edinburgh UK
| | - Katy Latham
- Anthony Nolan Research InstituteRoyal Free Hospital London UK
| | - David M. Turner
- Histocompatibility and Immunogenetics DepartmentScottish National Blood Transfusion Service Edinburgh UK
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24
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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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25
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Moszkowska G, Zielińska H, Zieliński M, Dukat-Mazurek A, Dębska-Zielkowska J, Lewandowska D, Durlik M, Dębska-Ślizień A, Trzonkowski P. Immune Algorithm Optimization for Organ Transplantation in Poland. Transplant Proc 2020; 52:2026-2032. [PMID: 32279916 DOI: 10.1016/j.transproceed.2020.02.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/16/2020] [Accepted: 02/22/2020] [Indexed: 02/04/2023]
Abstract
The lack of a uniform method for determining unacceptable HLA mismatches (UAMs) for organ transplantation worldwide has resulted in many different algorithms for donor-recipient matching. Here we present our proposal for changes to the current algorithm for immune evaluation of potential kidney recipients in Poland based on the experience of various transplantation centers. The most important finding of this article is an algorithm that stratifies the pretransplant immunologic risk based on strict laboratory criteria, enabling harmonization between transplant centers in Poland. This is because of a step-by-step algorithm for alloantibody assessment using solid-phase assays (SPA) and clearly defined technical issues, as well as cutoffs for reporting UAMs. Our novel approach focuses on a laboratory testing extension in the scope of HLA typing; detection and characterization of alloantibodies before transplantation; desensitization; and post-transplant monitoring. The proposed changes will allow for the assessment of clinically relevant anti-HLA antibodies with complement binding properties; the determination of UAMs in the potential donor; the calculation of virtual panel reactive antibodies (vPRA); the calculation of the recipient's immunologic rejection risk stratification; the assessment of the donor-recipient virtual cross-match (vXM); and the determination of the final recipient's selection for the biological cross-match testing. Collectively, the optimized algorithm permit for UAM verification is based on laboratory proofed data and will firmly improve organ allocation and transplant outcomes in Poland. We hope that this novel approach also improves the individual patient's risk stratification and future personalized treatment.
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Affiliation(s)
- Grażyna Moszkowska
- Department of Medical Immunology, Medical University of Gdańsk, Gdańsk, Poland; Immunology & Transplantology Clinical Laboratory, University Laboratory Medicine Centre, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Hanna Zielińska
- Department of Medical Immunology, Medical University of Gdańsk, Gdańsk, Poland; Immunology & Transplantology Clinical Laboratory, University Laboratory Medicine Centre, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Maciej Zieliński
- Department of Medical Immunology, Medical University of Gdańsk, Gdańsk, Poland; Immunology & Transplantology Clinical Laboratory, University Laboratory Medicine Centre, University Clinical Centre in Gdańsk, Gdańsk, Poland.
| | - Anna Dukat-Mazurek
- Immunology & Transplantology Clinical Laboratory, University Laboratory Medicine Centre, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Joanna Dębska-Zielkowska
- Immunology & Transplantology Clinical Laboratory, University Laboratory Medicine Centre, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Dorota Lewandowska
- Polish Transplant Coordinating Center "Poltransplant," Warsaw, Poland; Department of Transplant Medicine, Nephrology, and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplant Medicine, Nephrology, and Internal Diseases, Warsaw Medical University, Warsaw, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Trzonkowski
- Department of Medical Immunology, Medical University of Gdańsk, Gdańsk, Poland
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26
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Pinelli DF, Tambur AR. Virtual crossmatching for deceased donor transplantation: one size does not fit all. Kidney Int 2020; 97:659-662. [DOI: 10.1016/j.kint.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 01/08/2020] [Accepted: 02/06/2020] [Indexed: 10/24/2022]
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27
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Dean CL, Krummey SM, Gebel HM, Bray RA, Sullivan HC. Identification of a recurrent pattern of false-positivity by Luminex HLA MHC class I single antigen bead testing. Hum Immunol 2020; 81:73-78. [PMID: 31917024 DOI: 10.1016/j.humimm.2019.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/12/2019] [Accepted: 12/26/2019] [Indexed: 02/07/2023]
Abstract
Previously, a distinct MHC class II Luminex-single antigen bead (SAB) pattern was described and attributed to antibodies targeting denatured antigens. In this study, we describe a distinct MHC class I reactivity pattern observed in 1.8% (105/5992) of samples resulted in 2017. The pattern displays reactivity to the following Luminex-SABs: HLA-A*33:03, A*36:01, A*80:01, B*54:01, B*53:01, C*06:02, C*07:02, C*18:02, C*14:02, C*03:03, C*03:04, and C*15:02. This pattern was identified in patients with no sensitization history, negative FlowPRA results, and antibody to self-antigen(s). Epitope analysis failed to reveal a common determinant(s) to explain this pattern of reactivity. Additionally, we found this pattern to be prevalent in female patients (62%) and also those with systemic lupus erythematosus (62%). Given these findings, we speculate this pattern likely represents false-positive reactivity, possibly due to antibody targeting denatured antigens or a specific peptide, molecular mimicry, autoimmunity, or a combination thereof.
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Affiliation(s)
- Christina L Dean
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
| | - Scott M Krummey
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
| | - Howard M Gebel
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
| | - Robert A Bray
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
| | - Harold C Sullivan
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States.
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28
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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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29
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Mangiola M, Marrari M, Ensor C, Spycher MO, Berger M, Zeevi A. Therapeutic Human IgG Preparations Contain Mixture of HLA Antibodies to Native HLA Antigens and Cryptic Epitopes With Little Clinical Significance. Transplantation 2019; 102:2126-2132. [PMID: 29877923 DOI: 10.1097/tp.0000000000002312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human immunoglobulins (H-Ig) are widely used in solid organ transplantation for immunoglobulin G (IgG) replacement and for desensitization and treatment of antibody-mediated rejection. They are obtained from plasma pools and may contain HLA antibodies that can be detrimental to transplant recipients. The goal of this study was to evaluate HLA antibodies in multiple lots of 2 commercial H-Ig preparations by Luminex single-antigen bead (SAB) and cell-based crossmatch assays. METHODS Thirty lots of 2 commercial H-Ig products (CSL Behring, King of Prussia, PA) were evaluated: 6 Hizentra and 24 Privigen. All were adsorbed and diluted 1:10 before testing. HLA IgG antibodies were determined by 2 Luminex SAB kits and C1q screen for complement-binding capability. Lots were tested for the presence of antibody to denatured vs. intact class I HLA alleles using acid-treated SAB. Surrogate T and B-cell flow cytometry crossmatches (FCXM) were performed with peripheral blood lymphocytes from 2 healthy donors. RESULTS Twenty-two (73%) lots at 1:10 showed SAB reactivity with mean fluorescent intensity of 2000 or greater for HLA class I, 67% (20/30 lots) for class II. The reactivity pattern was similar using both SAB kits. Acid treatment revealed antibodies to denatured class I: the majority of HLA-C, half of HLA-B and few HLA-A alleles. No C1q reactivity was observed. Surrogate flow cytometry crossmatch results were positive (>150 median channel shift), but were fourfold to eightfold lower than expected. CONCLUSIONS The H-Ig products tested consisted of low titer, non-complement-binding HLA class I and class II antibodies; most of the observed class I HLA reactivity was toward denatured HLA antigens.
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Affiliation(s)
- Massimo Mangiola
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Marilyn Marrari
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Christopher Ensor
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA
| | | | | | - Adriana Zeevi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
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30
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Visentin J, Leu DL, Mulder A, Jambon F, Badier L, Lee JH, Guidicelli G, Bouthemy C, Ralazamahaleo M, Claas F, Di Primo C, Taupin JL. Measuring anti-HLA antibody active concentration and affinity by surface plasmon resonance: Comparison with the luminex single antigen flow beads and T-cell flow cytometry crossmatch results. Mol Immunol 2019; 108:34-44. [DOI: 10.1016/j.molimm.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/31/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022]
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31
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Ravindranath MH, Filippone EJ, Devarajan A, Asgharzadeh S. Enhancing Natural Killer and CD8 + T Cell-Mediated Anticancer Cytotoxicity and Proliferation of CD8 + T Cells with HLA-E Monospecific Monoclonal Antibodies. Monoclon Antib Immunodiagn Immunother 2019; 38:38-59. [PMID: 31009335 PMCID: PMC6634170 DOI: 10.1089/mab.2018.0043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/13/2019] [Indexed: 12/16/2022] Open
Abstract
Cytotoxic NK/CD8+ T cells interact with MHC-I ligands on tumor cells through either activating or inhibiting receptors. One of the inhibitory receptors is CD94/NKG2A. The NK/CD8+ T cell cytotoxic capability is lost when tumor-associated human leukocyte antigen, HLA-E, binds the CD94/NKG2A receptor, resulting in tumor progression and reduced survival. Failure of cancer patients to respond to natural killer (NK) cell therapies could be due to HLA-E overexpression in tumor tissues. Preventing the inhibitory receptor-ligand interaction by either receptor- or ligand-specific monoclonal antibodies (mAbs) is an innovative passive immunotherapeutic strategy for cancer. Since receptors and ligands can be monomeric or homo- or heterodimeric proteins, the efficacy of mAbs may rely on their ability to distinguish monospecific (private) functional epitopes from nonfunctional common (public) epitopes. We developed monospecific anti-HLA-E mAbs (e.g., TFL-033) that recognize only HLA-E-specific epitopes, but not epitopes shared with other HLA class-I loci as occurs with currently available polyreactive anti-HLA-E mAbs. Interestingly the amino acid sequences in the α1 and α2 helices of HLA-E, critical for the recognition of the mAb TFL-033, are strikingly the same sequences recognized by the CD94/NKG2A inhibitory receptors on NK/CD8+ cells. Such monospecific mAbs can block the CD94/NKG2A interaction with HLA-E to restore NK cell and CD8+ anticancer cell cytotoxicity. Furthermore, the HLA-E monospecific mAbs significantly promoted the proliferation of the CD4-/CD8+ T cells. These monospecific mAbs are also invaluable for the specific demonstration of HLA-E on tumor biopsies, potentially indicating those tumors most likely to respond to such therapy. Thus, they can be used to enhance passive immunotherapy once phased preclinical studies and clinical trials are completed. On principle, we postulate that NK cell passive immunotherapy should capitalize on both of these features of monospecific HLA-E mAbs, that is, the specific determination HLA-E expression on a particular tumor and the enhancement of NK cell/CD8+ cytotoxicity if HLA-E positive.
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Affiliation(s)
| | - Edward J Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Asokan Devarajan
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Shahab Asgharzadeh
- Department of Pediatrics and Pathology, Children's Hospital, Keck School of Medicine, USC, Los Angeles, California
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32
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Abstract
OBJECTIVES To provide an overview of the complexities associated with the human leukocyte antigen (HLA)-mediated platelet refractoriness. HLA antibody detection technologies and limitations associated with methodologies are discussed. METHODS A case scenario and review of relevant literature describing platelet refractoriness are presented, followed by a discussion of HLA antibody testing. RESULTS Following diagnosis of HLA-mediated refractoriness, a decision is made regarding the approach to obtain the appropriate platelets. The panel reactive antibodies (PRA) % of the patient, HLA typing, and limitations of the HLA testing should be taken into account when deciding which type of product would be the best option for a given patient. CONCLUSIONS Following confirmation and review of HLA antibody testing, platelets are ordered based upon the PRA% and approach employed, HLA-matched platelets, antigen restricted platelets, or cross-matched platelets. The platelets are transfused and a posttransfusion increment count is monitored to determine transfusion success.
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Affiliation(s)
- Amy E Schmidt
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Majed A Refaai
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Myra Coppage
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
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33
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Valenzuela NM, Askar M, Heidt S, Jindra P, Madbouly A, Pinelli D, Jackson A, Hidalgo LG. Minimal data reporting standards for serological testing for histocompatibility. Hum Immunol 2018; 79:865-868. [DOI: 10.1016/j.humimm.2018.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/15/2018] [Indexed: 12/30/2022]
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34
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Koefoed-Nielsen P, Møller BK. Donor-specific anti-HLA antibodies by solid phase immunoassays: advantages and technical concerns. Int Rev Immunol 2018; 38:95-105. [DOI: 10.1080/08830185.2018.1525367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Bjarne Kuno Møller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
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35
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Guillaume N. Improved flow cytometry crossmatching in kidney transplantation. HLA 2018; 92:375-383. [DOI: 10.1111/tan.13403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/11/2018] [Accepted: 09/28/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Nicolas Guillaume
- Department of Histocompatibility Amiens University Medical Center Amiens France
- EA HEMATIM Jules Verne University of Picardie Amiens France
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36
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Halloran PF, Reeve J, Aliabadi AZ, Cadeiras M, Crespo-Leiro MG, Deng M, Depasquale EC, Goekler J, Jouven X, Kim DH, Kobashigawa J, Loupy A, Macdonald P, Potena L, Zuckermann A, Parkes MD. Exploring the cardiac response to injury in heart transplant biopsies. JCI Insight 2018; 3:123674. [PMID: 30333303 DOI: 10.1172/jci.insight.123674] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/11/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Because injury is universal in organ transplantation, heart transplant endomyocardial biopsies present an opportunity to explore response to injury in heart parenchyma. Histology has limited ability to assess injury, potentially confusing it with rejection, whereas molecular changes have potential to distinguish injury from rejection. Building on previous studies of transcripts associated with T cell-mediated rejection (TCMR) and antibody-mediated rejection (ABMR), we explored transcripts reflecting injury. METHODS Microarray data from 889 prospectively collected endomyocardial biopsies from 454 transplant recipients at 14 centers were subjected to unsupervised principal component analysis and archetypal analysis to detect variation not explained by rejection. The resulting principal component and archetype scores were then examined for their transcript, transcript set, and pathway associations and compared to the histology diagnoses and left ventricular function. RESULTS Rejection was reflected by principal components PC1 and PC2, and by archetype scores S2TCMR, and S3ABMR, with S1normal indicating normalness. PC3 and a new archetype score, S4injury, identified unexplained variation correlating with expression of transcripts inducible in injury models, many expressed in macrophages and associated with inflammation in pathway analysis. S4injury scores were high in recent transplants, reflecting donation-implantation injury, and both S4injury and S2TCMR were associated with reduced left ventricular ejection fraction. CONCLUSION Assessment of injury is necessary for accurate estimates of rejection and for understanding heart transplant phenotypes. Biopsies with molecular injury but no molecular rejection were often misdiagnosed rejection by histology.TRAIL REGISTRATION. ClinicalTrials.gov NCT02670408FUNDING. Roche Organ Transplant Research Foundation, the University of Alberta Hospital Foundation, and Alberta Health Services.
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Affiliation(s)
- Philip F Halloran
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jeff Reeve
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Martin Cadeiras
- Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | | | - Mario Deng
- Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | | | | | | | - Daniel H Kim
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Peter Macdonald
- The Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Luciano Potena
- Cardiovascular Department, University of Bologna, Bologna, Italy
| | | | - Michael D Parkes
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada
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Abramowicz D, Oberbauer R, Heemann U, Viklicky O, Peruzzi L, Mariat C, Crespo M, Budde K, Oniscu GC. Recent advances in kidney transplantation: a viewpoint from the Descartes advisory board. Nephrol Dial Transplant 2018; 33:1699-1707. [PMID: 29342289 PMCID: PMC6168736 DOI: 10.1093/ndt/gfx365] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/10/2017] [Indexed: 02/06/2023] Open
Abstract
Transplantation medicine is a rapidly evolving field. Keeping afloat of the published literature to offer the best clinical care to our patients is a daunting task. As part of its educational mission, the Descartes advisory board identified seven topics in kidney transplantation where there has been substantial progresses over the last years: kidney allocation within Eurotransplant; kidney exchange strategies; kidney machine perfusion strategies; the changing landscape of anti-human leukocyte antigen (HLA) antibodies; the new immunosuppressive drugs in the pipeline; strategies for immunosuppression minimization; and the continuous enigma of focal segmental glomerular sclerosis recurrence after transplantation. Here, we have summarized the main knowledge and the main challenges of these seven topics with the aim to provide transplant professionals at large with key bullet points to successfully understand these new concepts.
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Affiliation(s)
- Daniel Abramowicz
- Department of Nephrology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - Rainer Oberbauer
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
- Department of Nephrology, KH Elisabethinen, Linz, Austria
| | - Uwe Heemann
- Department of Nephrology, Klinikum Rechts der Isar, München, Germany
| | - Ondrej Viklicky
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague 4, Czech Republic
| | - Licia Peruzzi
- Nephrology and Dialysis Department, Regina Margherita Hospital, Torino, Italy
| | - Christophe Mariat
- Department of Nephrological Intensive Care, University Jean Monnet, Saint Etienne, France
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar Barcelona, Barcelona, Spain
| | - Klemens Budde
- Department of Nephrology, Charité—Universitätsmedizin Berlin, Berlin, Germany
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Karahan GE, Claas FHJ, Heidt S. Technical challenges and clinical relevance of single antigen bead C1q/C3d testing and IgG subclass analysis of human leukocyte antigen antibodies. Transpl Int 2018; 31:1189-1197. [DOI: 10.1111/tri.13327] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/21/2018] [Accepted: 08/03/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Gonca E. Karahan
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden the Netherlands
| | - Frans H. J. Claas
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden the Netherlands
| | - Sebastiaan Heidt
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden the Netherlands
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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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Abstract
Purpose of review Accurate and timely detection and characterization of human leukocyte antigen (HLA) antibodies are critical for pre-transplant and post-transplant immunological risk assessment. Solid phase immunoassays have provided increased sensitivity and specificity, but test interpretation is not always straightforward. This review will discuss the result interpretation considering technical limitations; assessment of relative antibody strength; and the integration of data for risk stratification from complementary testing and the patient's immunological history. Recent findings Laboratory and clinical studies have provided insight into causes of test failures – false positive reactions because of antibodies to denatured HLA antigens and false negative reactions resulting from test interference and/or loss of native epitopes. Test modifications permit detection of complement-binding antibodies and determination of the IgG subclasses. The high degree of specificity of single antigen solid phase immunoassays has revealed the complexity and clinical relevance of antibodies to HLA-C, HLA-DQ, and HLA-DP antigens. Determination of antibody specificity for HLA epitopes enables identification of incompatible antigens not included in test kits. Summary Detection and characterization of HLA antibodies with solid phase immunoassays has led to increased understanding of the role of those antibodies in graft rejection, improved treatment of antibody-mediated rejection, and increased opportunities for transplantation. However, realization of these benefits requires careful and accurate interpretation of test results.
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Halloran PF, Potena L, Van Huyen JPD, Bruneval P, Leone O, Kim DH, Jouven X, Reeve J, Loupy A. Building a tissue-based molecular diagnostic system in heart transplant rejection: The heart Molecular Microscope Diagnostic (MMDx) System. J Heart Lung Transplant 2017; 36:1192-1200. [DOI: 10.1016/j.healun.2017.05.029] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 01/08/2023] Open
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Ravindranath MH, Jucaud V, Ferrone S. Monitoring native HLA-I trimer specific antibodies in Luminex multiplex single antigen bead assay: Evaluation of beadsets from different manufacturers. J Immunol Methods 2017; 450:73-80. [PMID: 28782523 PMCID: PMC8715512 DOI: 10.1016/j.jim.2017.07.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 02/01/2023]
Abstract
Luminex single antigen bead (SAB) assay utilizes beadsets coated with a set of cloned and purified HLA molecules, for monitoring serum anti-HLA antibodies. Particularly, the level of serum IgG against native HLA-I trimers (heavy chain (HC) and β2-microglobulin (β2m) with a peptide), expressed in allograft tissues is correlated with graft failure. In addition to native trimeric HLAI, the beadsets may carry HC only or the dimeric variants, peptide-free HC with β2m and β2m-free HC with or without peptides. Currently, three different HLA-I coated beadsets have been produced commercially. The HLA antigen density on one beadset was reported to be approximately 50% of that present on another beadset as evidenced by the binding of an anti-HLA-I mAb W6/32. To date, no efforts have been made to compare the relative distribution of HLA-I variants in these three beadsets. In this study, using monoclonal antibodies (W6/32, HC-10 and TFL-006) that can distinguish the structural variants based on their epitope specificities, the nature of the variants in the three beadsets were comparatively evaluated. One beadset (Beadset A, see Materials and methods for Brand and Manufacturer's names) (W6/32+/HC-10+/TFL-006+) carried at least three variants, while beadset B (W6/32+/HC-10+/TFL-006-) carried two (peptide-associated and peptide-free β2m-HC) and the beadset C (W6/32+/HC-10-/TFL-006-) carried exclusively the HLA-I trimer suggesting its usefulness for specific monitoring native HLA-I trimer antibodies. Because of the salient differences in the variants coated on the different beadsets, it would be warranted to investigate, if these differences are clinically relevant for monitoring serum anti-HLA antibodies in sensitized patients waiting for donor organs and in allograft recipients (274).
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Affiliation(s)
| | - Vadim Jucaud
- Terasaki Foundation Laboratory, Los Angeles, CA, United States
| | - Soldano Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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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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Liwski RS, Greenshields AL, Murphey C, Bray RA, Gebel HM. It’s about time: The development and validation of a rapid optimized single antigen bead (ROB) assay protocol for LABScreen. Hum Immunol 2017; 78:489-499. [DOI: 10.1016/j.humimm.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/27/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
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Sullivan HC, Liwski RS, Bray RA, Gebel HM. The Road to HLA Antibody Evaluation: Do Not Rely on MFI. Am J Transplant 2017; 17:1455-1461. [PMID: 28199773 PMCID: PMC8663029 DOI: 10.1111/ajt.14229] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/22/2017] [Accepted: 02/04/2017] [Indexed: 01/25/2023]
Abstract
Technological advances in HLA laboratory testing undoubtedly improved the sensitivity and specificity of HLA antibody assessment but not without introducing a set of challenges regarding data interpretation. In particular, the introduction of solid-phase single-antigen bead (SAB) antibody assessment brought the belief that mean fluorescence intensity (MFI) was a quantifiable value. As such, MFI levels heavily influenced HLA antibody reporting, monitoring, and clinical practice. However, given that SAB testing was neither intended for nor approved to be quantifiable, is the use of MFI in current clinical and laboratory practice valid? What, if anything, does this numerical value actually reveal about the pathogenic potential of the antibody? What are the pitfalls and caveats associated with reporting MFI? Herein, we travel the road to HLA antibody assessment and explore the reliability of MFI values to make clinical decisions.
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Affiliation(s)
- H. C. Sullivan
- Department of Pathology, Emory University Hospital, Atlanta, GA
| | - R. S. Liwski
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R. A. Bray
- Department of Pathology, Emory University Hospital, Atlanta, GA
| | - H. M. Gebel
- Department of Pathology, Emory University Hospital, Atlanta, GA,Corresponding author: Howard M. Gebel,
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Conformational Variants of the Individual HLA-I Antigens on Luminex Single Antigen Beads Used in Monitoring HLA Antibodies: Problems and Solutions. Transplantation 2017; 101:764-777. [PMID: 27495776 DOI: 10.1097/tp.0000000000001420] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Single antigen beads (SAB) are used for monitoring HLA antibodies in pretransplant and posttransplant patients despite the discrepancy between virtual and actual crossmatch results and transplant outcomes. This discrepancy can be attributed to the presence of conformational variants of HLA-I on SAB, assessment of which would increase the concordance between SAB and flow cytometry crossmatch (FCXM) results, thus enabling improved organ accessibility for the waiting list patients and a better prediction of antibody-mediated rejection. METHODS The conformational variants were examined on HLA-I beads, iBeads, acid-/alkali-treated beads, and T cells using HLA-I monoclonal antibodies (W6/32, TFL-006, and heavy chain (HC)-10). RESULTS The affinity of the monoclonal antibodies against HLA-I beads confirmed the presence and heterogeneous density of peptide-associated β2-microglobulin-associated HLA HC (pepA-β2aHC), peptide-free-β2aHC (pepF-β2aHC), and β2-free HC (β2fHC) on every single antigen-coated bead. In contrast, iBeads harbor a high density of pepA-β2aHC, low density of pepF-β2aHC, and are lacking β2fHC. The FCXM analyses confirmed the prevalence of pepA-β2aHC, but not pepF-β2aHC or β2fHC on resting T cells. CONCLUSIONS The strength of a donor-specific antibody should be assessed with a bead-specific mean fluorescence intensity cutoff based on TFL-006 reactivity against HLA-I beads, and HC-10 against iBeads, where the β2fHC or pepF-β2aHC normalized donor-specific antibody level would reveal the true anti-pepA-β2aHC reactivity associated with positive FCXM.
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Nakamura J, Nakajima F, Kamada H, Tadokoro K, Nagai T, Satake M. Males without apparent alloimmunization could have HLA antibodies that recognize target HLA specificities expressed on cells. HLA 2017; 89:285-292. [DOI: 10.1111/tan.13000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/18/2017] [Accepted: 02/10/2017] [Indexed: 11/26/2022]
Affiliation(s)
- J. Nakamura
- Central Blood Institute; Japanese Red Cross Society; Tokyo Japan
| | - F. Nakajima
- Central Blood Institute; Japanese Red Cross Society; Tokyo Japan
| | - H. Kamada
- Central Blood Institute; Japanese Red Cross Society; Tokyo Japan
| | - K. Tadokoro
- Blood Service Headquarters; Japanese Red Cross Society; Tokyo Japan
| | - T. Nagai
- Central Blood Institute; Japanese Red Cross Society; Tokyo Japan
| | - M. Satake
- Central Blood Institute; Japanese Red Cross Society; Tokyo Japan
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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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