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Bakis H, Bouthemy C, Corcuff JB, Lauro C, Guidicelli G, Cargou M, Guibet C, Taton B, Merville P, Couzi L, Moreau K, Visentin J. 25-hydroxyvitamin D sufficiency is associated with lower de novo anti-HLA donor specific antibody and better kidney transplant outcomes. HLA 2024; 103:e15187. [PMID: 37604171 DOI: 10.1111/tan.15187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/30/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
T-cell mediated rejection (TCMR), de novo anti-HLA donor-specific antibodies (dnDSAs) and ensuing antibody-mediated rejection (ABMR) reduce kidney transplantation (KT) survival. The immunomodulatory effects of 25-hydroxyvitamin D [25(OH)D] could be beneficial for KT outcomes. We aimed to evaluating the association between 25(OH)D levels, the development of dnDSAs, clinical TCMR and ABMR, and graft survival. This single center retrospective study included 253 KT recipients (KTRs) transplanted without preformed DSA between 2010 and 2013. We measured 25(OH)D in successive serum samples: at KT (M0) and M12 for the entire cohort, and additionally at M24 and/or M36 when sera were available. We assessed graft outcomes up to 5 years post-KT. The proportion of KTRs having sufficient 25(OH)D at KT (M0) was high (81.4%) and then dropped at M12 (71.1%). KTRs with sufficient 25(OH)D at M0 experienced less clinical TCMR (HR, 0.41; 95% CI, 0.19-0.88 in multivariate analysis). A sufficient 25(OH)D at M12 was independently associated with a longer dnDSA-free survival (HR, 0.34; 95% CI, 0.17-0.69). There was no association between 25(OH)D and clinical AMBR. Studying the KTRs with 25(OH)D measurements at M12, M24 and M36 (n = 203), we showed that 25(OH)D sufficiency over the 3 first-years post-KT was associated with a longer graft survival in multivariate analyses (HR, 0.39; 95% CI, 0.22-0.70). To our knowledge, this study is the first showing an association between 25(OH)D sufficiency post-KT and dnDSA occurrence in KTRs. Moreover, we reinforce previously published data showing an association between 25(OH)D, TCMR and graft survival in KT.
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Affiliation(s)
- Hugo Bakis
- CHU de Bordeaux, Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Bordeaux, France
| | - Charlène Bouthemy
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France
- Univ. Bordeaux, CNRS, INSERM, ImmunoConcEpT, UMR 5164, Bordeaux, France
| | - Jean-Benoît Corcuff
- CHU de Bordeaux, Laboratoire d'Hormonologie et de Médecine Nucléaire, Hôpital Pellegrin, Bordeaux, France
- Univ. Bordeaux, Nutrition and Integrated Neurobiology, UMR INRA 1286, Bordeaux, France
| | - Cindy Lauro
- CHU de Bordeaux, Laboratoire d'Hormonologie et de Médecine Nucléaire, Hôpital Pellegrin, Bordeaux, France
| | - Gwendaline Guidicelli
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France
| | - Marine Cargou
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France
| | - Claire Guibet
- CHU de Bordeaux, Laboratoire d'Hormonologie et de Médecine Nucléaire, Hôpital Pellegrin, Bordeaux, France
| | - Benjamin Taton
- CHU de Bordeaux, Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Bordeaux, France
- Univ. Bordeaux, Univ. Bordeaux, Inria Bordeaux Sud-Ouest, Bordeaux, France
| | - Pierre Merville
- CHU de Bordeaux, Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Bordeaux, France
- Univ. Bordeaux, CNRS, INSERM, ImmunoConcEpT, UMR 5164, Bordeaux, France
| | - Lionel Couzi
- CHU de Bordeaux, Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Bordeaux, France
- Univ. Bordeaux, CNRS, INSERM, ImmunoConcEpT, UMR 5164, Bordeaux, France
| | - Karine Moreau
- CHU de Bordeaux, Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Bordeaux, France
| | - Jonathan Visentin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France
- Univ. Bordeaux, CNRS, INSERM, ImmunoConcEpT, UMR 5164, Bordeaux, France
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Couzi L, Malvezzi P, Amrouche L, Anglicheau D, Blancho G, Caillard S, Freist M, Guidicelli GL, Kamar N, Lefaucheur C, Mariat C, Koenig A, Noble J, Thaunat O, Thierry A, Taupin JL, Bertrand D. Imlifidase for Kidney Transplantation of Highly Sensitized Patients With a Positive Crossmatch: The French Consensus Guidelines. Transpl Int 2023; 36:11244. [PMID: 37448448 PMCID: PMC10336835 DOI: 10.3389/ti.2023.11244] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/02/2023] [Indexed: 07/15/2023]
Abstract
Imlifidase recently received early access authorization for highly sensitized adult kidney transplant candidates with a positive crossmatch against an ABO-compatible deceased donor. These French consensus guidelines have been generated by an expert working group, in order to homogenize patient selection, associated treatments and follow-up. This initiative is part of an international effort to analyze properly the benefits and tolerance of this new costly treatment in real-life. Eligible patients must meet the following screening criteria: cPRA ≥ 98%, ≤ 65-year of age, ≥ 3 years on the waiting list, and a low risk of biopsy-related complications. The final decision to use Imlifidase will be based on the two following criteria. First, the results of a virtual crossmatch on recent serum, which shall show a MFI for the immunodominant donor-specific antibodies (DSA) > 6,000 but the value of which does not exceed 5,000 after 1:10 dilution. Second, the post-Imlifidase complement-dependent cytotoxicity crossmatch must be negative. Patients treated with Imlifidase will receive an immunosuppressive regimen based on steroids, rATG, high dose IVIg, rituximab, tacrolimus and mycophenolic acid. Frequent post-transplant testing for DSA and systematic surveillance kidney biopsies are highly recommended to monitor post-transplant DSA rebound and subclinical rejection.
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Affiliation(s)
- Lionel Couzi
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- CNRS-UMR 5164 Immuno ConcEpT, Université de Bordeaux, Bordeaux, France
| | - Paolo Malvezzi
- Centre Hospitalier Universitaire de Grenoble, La Tronche, France
| | | | | | - Gilles Blancho
- Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France
| | | | - Marine Freist
- Centre Hospitalier Emile Roux, Le Puy-en-Velay, France
| | | | - Nassim Kamar
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Christophe Mariat
- Centre Hospitalier Universitaire (CHU) de Saint-Étienne, Saint-Etienne, France
| | | | - Johan Noble
- Centre Hospitalier Universitaire de Grenoble, La Tronche, France
| | | | - Antoine Thierry
- Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
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Norin AJ, Das B, Mondragon-Escorpizo MO, Bajaj H, Sumrani N, John D, Salifu MO. Determination of unacceptable antigens by summation of anti-HLA eplet antibody strength (MFI) based on single antigen bead assays: Excellent correlation with negative cell based cross matches. Hum Immunol 2022; 83:482-493. [DOI: 10.1016/j.humimm.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/04/2022]
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Wojciechowski E, Jambon F, Cargou M, Guidicelli G, Merville P, Couzi L, Taupin JL, Visentin J. Stability of Anti-HLA Sensitization Profiles in Highly Sensitized Kidney Transplantation Candidates: Toward a Rational Serological Testing Strategy. Transplantation 2022; 106:869-878. [PMID: 34028385 DOI: 10.1097/tp.0000000000003822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Highly sensitized (HS) anti-HLA patients awaiting kidney transplantation benefit from specific allocation programs. Serological monitoring at 3-mo intervals is recommended to prevent unexpected positive crossmatch (XM), but this strategy is not evidence-based. Therefore, we assessed its relevance when using single-antigen flow bead (SAFB) and screening flow bead (SFB) assays. METHODS We included 166 HS patients awaiting a transplant and assessed their SAFB profile during the year preceding their inclusion. Anti-HLA antibodies were evaluated by SAFB assay and compared within patients as serum pairs at 3, 6, and 9 mo. We assessed the performance of SFB for detecting changes in SAFB profiles with 35 serum pairs. RESULTS On comparing 354, 218, and 107 serum pairs at 3, 6, and 9 mo, respectively, only 0.6%, 0.7%, and 1% of all antigens tested exceeded for the first time the unacceptable antigen threshold (mean fluorescence intensity ≥2000) in the most recent sample. Irrespective of the follow-up period, the calculated panel-reactive antibodies increased by a mean of 1%, and there was no significant increase in the proportion of donors at risk for positivity of flow- or complement-dependent cytotoxicity XM. The SFB did not accurately detect the variations of SAFB profiles. CONCLUSIONS Changes in HS patient profiles are anecdotal and show little association with transplant access or risk for positive XM. Less-frequent monitoring in HS patients should be considered to improve cost-effectiveness without affecting transplant safety.
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Affiliation(s)
- Elodie Wojciechowski
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France
- Université Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
| | - Frédéric Jambon
- Université Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
- CHU de Bordeaux, Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France
| | - Marine Cargou
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France
- Université Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
| | - Gwendaline Guidicelli
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France
| | - Pierre Merville
- Université Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
- CHU de Bordeaux, Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France
| | - Lionel Couzi
- Université Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
- CHU de Bordeaux, Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France
| | - Jean-Luc Taupin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France
- Université Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
| | - Jonathan Visentin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France
- Université Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux, France
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5
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Hiho SJ, Levvey B, Carroll R, Nicolson I, Mihaljcic M, Diviney MB, Snell GI, Sullivan LC, Westall GP. The clinical utility and thresholds of Virtual and Halifaster Flow crossmatches in lung transplantation. HLA 2022; 99:580-589. [PMID: 35340124 DOI: 10.1111/tan.14613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Immune sensitization, defined as the presence of alloreactive donor-specific antibodies (DSA), is associated with increased wait-times and inferior transplant outcomes. Identifying pre-transplant DSA with a physical cell-based assay is critical in defining immunological risk. However, improved solid phase antibody detection has provided the potential to forgo this physical assay. Here, we evaluated the association between DSA mean fluorescence intensity (MFI) and the recently introduced Halifaster Flow cytometry crossmatch (FXM) to determine if MFI could predict the outcome of FXM and whether a virtual crossmatch (VXM) would provide an accurate risk assessment. METHODS Sera from 134 waitlisted lung patients was retrospectively assessed by Halifaster FXM against lymphocytes preparations from 32 donors, resulting in 265 FXMs. HLA typing was performed to 2-field allelic level and Luminex single antigen beads (SAB) used to identify DSA. The association between FXM and Luminex MFI was calculated using ROC analysis. MFI threshold accuracy was confirmed using a separate validation cohort (174 recipient sera and 34 donors), whereby both virtual crossmatch (VXM) and FXMs were compared. RESULTS From the 265 FXM performed, 48 (18%) T-cell (TFXM) and 56 (21%) B-cell (BFXM) were positive. In the evaluation cohort, MFI thresholds of 2000 for HLA-A, B, DRB1 and >4000 for DQB1, were predictive of a positive FXM. The validation cohort of 233 paired FXM and VXM confirmed these MFI thresholds for both TFXM and BFXM with an accuracy of 91.4% and 89.3% respectively. CONCLUSION A positive VXM, defined with HLA-specific MFI thresholds predicts Halifaster FXM reactivity, and can potentially expedite organ allocation, by minimising the need for the more time-consuming flow cytometry crossmatch. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Steven J Hiho
- Lung Transplant Service, Department of Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Australia.,Australian Red Cross LifeBlood, Victorian Transplantation and Immunogenetics, Melbourne, Australia
| | - Bronwyn Levvey
- Lung Transplant Service, Department of Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Australia
| | - Robert Carroll
- Australian Red Cross LifeBlood, Victorian Transplantation and Immunogenetics, Melbourne, Australia.,Medical Sciences University of South Australia, Australia
| | - Ian Nicolson
- Australian Red Cross LifeBlood, Victorian Transplantation and Immunogenetics, Melbourne, Australia
| | - Masa Mihaljcic
- Australian Red Cross LifeBlood, Victorian Transplantation and Immunogenetics, Melbourne, Australia
| | - Mary B Diviney
- Australian Red Cross LifeBlood, Victorian Transplantation and Immunogenetics, Melbourne, Australia
| | - Gregory I Snell
- Lung Transplant Service, Department of Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Australia
| | - Lucy C Sullivan
- Lung Transplant Service, Department of Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Australia.,Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Australia.,Australian Red Cross LifeBlood, South Australian Transplantation and Immunogenetics, Adelaide, Australia
| | - Glen P Westall
- Lung Transplant Service, Department of Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Australia
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6
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Olszowska-Zaremba N, Zagożdżon R, Gozdowska J. Accuracy of virtual crossmatch (VXM) prediction of physical crossmatch (PXM) results of donor specific antibody (DSA) in routine pretransplant settings–A single-center experience. Transpl Immunol 2022; 72:101583. [DOI: 10.1016/j.trim.2022.101583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/26/2022]
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7
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Savoye E, Legeai C, Branchereau J, Gay S, Riou B, Gaudez F, Veber B, Bruyere F, Cheisson G, Kerforne T, Badet L, Bastien O, Antoine C. Optimal donation of kidney transplants after controlled circulatory death. Am J Transplant 2021; 21:2424-2436. [PMID: 36576341 DOI: 10.1111/ajt.16425] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
Controlled donation after circulatory death (cDCD) is used for "extended criteria" donors with poorer kidney transplant outcomes. The French cDCD program started in 2015 and is characterized by normothermic regional perfusion, hypothermic machine perfusion, and short cold ischemia time. We compared the outcomes of kidney transplantation from cDCD and brain-dead (DBD) donors, matching cDCD and DBD kidney transplants by propensity scoring for donor and recipient characteristics. The matching process retained 442 of 499 cDCD and 809 of 6185 DBD transplantations. The DGF rate was 20% in cDCD recipients compared with 28% in DBD recipients (adjusted relative risk [aRR], 1.43; 95% confidence interval [CI] 1.12-1.82). When DBD transplants were ranked by cold ischemia time and machine perfusion use and compared with cDCD transplants, the aRR of DGF was higher for DBD transplants without machine perfusion, regardless of the cold ischemia time (aRR with cold ischemia time <18 h, 1.57; 95% CI 1.20-2.03, vs aRR with cold ischemia time ≥18 h, 1.79; 95% CI 1.31-2.44). The 1-year graft survival rate was similar in both groups. Early outcome was better for kidney transplants from cDCD than from matched DBD transplants with this French protocol.
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Affiliation(s)
- Emilie Savoye
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Camille Legeai
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Julien Branchereau
- Department of Urology, Nantes University Hospital, University of Nantes, Nantes, France
| | - Samuel Gay
- Intensive Care Unit, Centre Hospitalier Annecy-genevois, Annecy, France
| | - Bruno Riou
- Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francois Gaudez
- Department of Urology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Veber
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | | | - Gaelle Cheisson
- Department of Surgical Anesthesia and Intensive Care, South Paris University hospital, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Thomas Kerforne
- Anesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Lionel Badet
- Groupement Hospitalier Edouard Herriot, Service d'urologie chirurgie de la Transplantation, Lyon, France
| | - Olivier Bastien
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Corinne Antoine
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
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Bertrand D, Kaveri R, Laurent C, Gatault P, Jauréguy M, Garrouste C, Sayegh J, Bouvier N, Caillard S, Lanfranco L, Thierry A, François A, Hau F, Etienne I, Guerrot D, Farce F. Intensity of de novo DSA detected by Immucor Lifecodes assay and C3d fixing antibodies are not predictive of subclinical ABMR after Kidney Transplantation. PLoS One 2021; 16:e0249934. [PMID: 33886604 PMCID: PMC8062066 DOI: 10.1371/journal.pone.0249934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/27/2021] [Indexed: 01/06/2023] Open
Abstract
De novo donor-specific antibodies (dnDSA) are associated with antibody-mediated rejection (ABMR) and allograft loss. We tested Immucor* (IM) Luminex Single-antigen beads (LSAB) assay and C3d-fixing antibodies in the setting of dnDSA and subclinical (s) ABMR. This retrospective multicentric study included 123 patients biopsied because of the presence of subclinical de novo DSA detected by One Lamda* Labscreen (MFI > 1000). In 112 patients, sera of the day of the biopsy were available and tested in a central lab with IM Lifecodes LSAB and C3d fixing antibodies assays. In 16 patients (14.3%), no DSA was detected using Immucor test. In 96 patients, at least one DSA was determined with IM. Systematic biopsies showed active sABMR in 30 patients (31.2%), chronic active sABMR in 17 patients (17.7%) and no lesions of sABMR in 49 KT recipients (51%). Intensitity criteria (BCM, BCR and AD-BCR) of DSA were not statistically different between these 3 histological groups. The proportion of patients with C3d-fixing DSA was not statistically different between the 3 groups and did not offer any prognostic value regarding graft survival. Performing biopsy for dnDSA could not be guided by the intensity criteria of IM LSAB assay. C3d-fixing DSA do not offer added value.
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Affiliation(s)
- Dominique Bertrand
- Nephrology Kidney Transplantation Dialysis, CHU Rouen, Rouen, France
- * E-mail:
| | | | - Charlotte Laurent
- Nephrology Kidney Transplantation Dialysis, CHU Rouen, Rouen, France
| | | | - Maïté Jauréguy
- Nephrology Kidney Transplantation, CHU Amiens, Amiens, France
| | - Cyril Garrouste
- Nephrology Kidney Transplantation, CHU Clermont Ferrand, Clermont Ferrand, France
| | - Johnny Sayegh
- Nephrology Kidney Transplantation, CHU Angers, Angers, France
| | | | - Sophie Caillard
- Nephrology Kidney Transplantation, CHU Strasbourg, Strasbourg, France
| | - Luca Lanfranco
- Nephrology Kidney Transplantation, CHU Brest, Brest, France
| | - Antoine Thierry
- Nephrology Kidney Transplantation, CHU Poitiers, Poitiers, France
| | | | | | - Isabelle Etienne
- Nephrology Kidney Transplantation Dialysis, CHU Rouen, Rouen, France
| | - Dominique Guerrot
- Nephrology Kidney Transplantation Dialysis, CHU Rouen, Rouen, France
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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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10
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Filippone EJ, Das B, Norin AJ, Ravindranath MH. Optimizing the assessment of pathogenic anti-HLA antibodies. Am J Transplant 2021; 21:431-432. [PMID: 32515088 DOI: 10.1111/ajt.16127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Edward J Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ballabh Das
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Allen J Norin
- Department of Medicine and Cell Biology, Transplant Immunology and Immunogenetics, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Mepur H Ravindranath
- Department of Hematology and Oncology, Children's Hospital, Los Angeles, California, USA
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11
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Bachelet T, Visentin J, Davis P, Taton B, Guidicelli G, Kaminski H, Merville P, Couzi L. The incidence of post-transplant malignancies in kidney transplant recipients treated with Rituximab. Clin Transplant 2020; 35:e14171. [PMID: 33247459 DOI: 10.1111/ctr.14171] [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: 05/12/2020] [Revised: 10/01/2020] [Accepted: 11/19/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Rituximab has been proposed as induction therapy in kidney transplant recipients (KTRs) with preformed donor-specific antibodies (DSA) or a positive flow cross-match. We here evaluated whether adding rituximab was associated with a higher incidence of post-transplant malignancies (PTM) due to greater immunosuppression. PATIENTS AND METHODS Forty-eight HLA-sensitized KTRs received induction therapy with anti-thymocyte globulin (ATG) and rituximab because of preformed DSA or a positive flow cross-match (RTX group). They were compared with a control group of 154 patients receiving ATG alone. RESULTS Thirty-nine of 202 (19.3%) patients developed PTM; the rate was similar in the RTX and no-RTX groups (14.6% vs. 20.8%, respectively, P = .3). The distributions of the types of cancer were similar between the two groups, with the majority being non-melanoma skin cancer (NMSC, n = 24). The risk factors for PTM were male gender, age, history of cancer, and azathioprine. CONCLUSION Our data do not indicate a higher rate of post-transplantation de novo malignancies after kidney transplantation in high-immunological risk patients who received induction therapy based on ATG and rituximab.
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Affiliation(s)
- Thomas Bachelet
- Clinique Saint-Augustin-CTMR, Bordeaux, ELSAN, France.,Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France
| | - Jonathan Visentin
- Immunology and Immunogenetics Laboratory, Bordeaux University Hospital, Bordeaux, France.,ImmunoConcEpT UMR 5164, Bordeaux University, CNRS, Bordeaux, France
| | - Philippine Davis
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Taton
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France
| | - Gwendaline Guidicelli
- Immunology and Immunogenetics Laboratory, Bordeaux University Hospital, Bordeaux, France
| | - Hannah Kaminski
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France.,ImmunoConcEpT UMR 5164, Bordeaux University, CNRS, Bordeaux, France
| | - Pierre Merville
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France.,ImmunoConcEpT UMR 5164, Bordeaux University, CNRS, Bordeaux, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France.,ImmunoConcEpT UMR 5164, Bordeaux University, CNRS, Bordeaux, France
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12
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Jambon F, Merville P, Guidicelli G, Taton B, De Précigout V, Couzi L, Moreau K, Visentin J. Efficacy of plasmapheresis and semi-selective immunoadsorption for removal of anti-HLA antibodies. J Clin Apher 2020; 36:291-298. [PMID: 33253430 DOI: 10.1002/jca.21858] [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: 03/06/2020] [Revised: 08/10/2020] [Accepted: 11/12/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND In organ transplantation, apheresis is frequently used for removal of anti-HLA antibodies. However, it is unclear whether plasmapheresis (PP) or semi-selective immunoadsorption (IA) should be employed, and the optimal number of apheresis sessions required to reach post-treatment objectives is also unknown. METHODS We enrolled 43 patients from Bordeaux University Hospital who were treated with PP (n = 29) or IA (n = 14) for antibody-mediated rejection or pre-transplant desensitization. Using Luminex single-antigen flow beads, we assessed the initial mean fluorescence intensity (MFI) of 1416 positive beads with MFIs obtained after 7 to 8 apheresis sessions (extended protocol) and, if a serum was available, after the first four sessions (short protocol). RESULTS MFI reduction after extended apheresis protocol was stronger with IA [87% (61%-100%)] than with PP [73% (22%-100%)] (P < .001). Indeed, 59% of the beads had a final MFI < 2000 with IA, whereas only 38% with PP (P < .001). The efficacy of removal depended on initial MFI but not on HLA specificity. A short protocol of apheresis showed excellent results without superiority of IA over PP for antibodies with an initial MFI < 3000. For antibodies showing MFI ≥2000 after four sessions, the residual MFI predicted the effectiveness of four additional sessions. CONCLUSION Monitoring the MFI of anti-HLA antibodies before and during apheresis protocol can guide physicians in the selection of apheresis technique and the number of sessions to be performed.
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Affiliation(s)
- Frédéric Jambon
- Service de Néphrologie-transplantation-dialyse-aphérèses, CHU de Bordeaux, Bordeaux, France.,CNRS UMR 5164, ImmunoConcEpT, Univ. Bordeaux, Bordeaux, France
| | - Pierre Merville
- Service de Néphrologie-transplantation-dialyse-aphérèses, CHU de Bordeaux, Bordeaux, France.,CNRS UMR 5164, ImmunoConcEpT, Univ. Bordeaux, Bordeaux, France
| | - Gwendaline Guidicelli
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France
| | - Benjamin Taton
- Service de Néphrologie-transplantation-dialyse-aphérèses, CHU de Bordeaux, Bordeaux, France
| | - Valérie De Précigout
- Service de Néphrologie-transplantation-dialyse-aphérèses, CHU de Bordeaux, Bordeaux, France
| | - Lionel Couzi
- Service de Néphrologie-transplantation-dialyse-aphérèses, CHU de Bordeaux, Bordeaux, France.,CNRS UMR 5164, ImmunoConcEpT, Univ. Bordeaux, Bordeaux, France
| | - Karine Moreau
- Service de Néphrologie-transplantation-dialyse-aphérèses, CHU de Bordeaux, Bordeaux, France
| | - Jonathan Visentin
- CNRS UMR 5164, ImmunoConcEpT, Univ. Bordeaux, Bordeaux, France.,CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France
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13
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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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14
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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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15
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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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16
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Cargou M, Elsermans V, Top I, Guidicelli G, Visentin J. Characterization of the novel
HLA‐DPB1*1098:01N
allele by sequencing‐based typing. HLA 2020; 96:249-251. [DOI: 10.1111/tan.13953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Marine Cargou
- CHU de Bordeaux, Laboratoire d'Immunologie et ImmunogénétiqueHôpital Pellegrin, Place Amélie Raba Léon Bordeaux France
- Université de BordeauxUMR CNRS 5164 Immunoconcept Bordeaux France
| | | | - Isabelle Top
- CHRU de Lille, Institut d'Immunologie‐HLA Lille France
| | - Gwendaline Guidicelli
- CHU de Bordeaux, Laboratoire d'Immunologie et ImmunogénétiqueHôpital Pellegrin, Place Amélie Raba Léon Bordeaux France
| | - Jonathan Visentin
- CHU de Bordeaux, Laboratoire d'Immunologie et ImmunogénétiqueHôpital Pellegrin, Place Amélie Raba Léon Bordeaux France
- Université de BordeauxUMR CNRS 5164 Immunoconcept Bordeaux France
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17
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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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18
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Carey BS, Poulton KV, Poles A. HLA expression levels of unstimulated and cytokine stimulated human umbilical vein endothelial cells. HLA 2020; 95:505-515. [PMID: 31981308 DOI: 10.1111/tan.13808] [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: 10/24/2019] [Revised: 01/11/2020] [Accepted: 01/17/2020] [Indexed: 12/12/2022]
Abstract
Transplant rejection occurs following recipient recognition of mismatched HLA on donor tissue, but active rejection is dependent not only upon the severity of the T cell or alloantibody response, but also upon the cell surface expression of target HLA molecules. To investigate the variation in HLA expression using a model of endothelium, human umbilical vein endothelial cell (HUVEC) cultures were generated from 48 umbilical cords donated consecutively following planned caesarean section. HUVECs were stimulated using the cytokines tumour necrosis factor alpha and interferon gamma and HLA expression of unstimulated and stimulated cells determined using flow cytometry. HLA-A2, HLA-A3 and HLA-C antigens all showed a modest increase in expression for 12 hours post cell activation, followed by a more pronounced response over the next 24 to 36 hours. Each of these antigens increased by up to 40 times over unstimulated levels and in addition cells homozygous for specific HLA antigens on average had twice the amount of antigen expressed compared with cells heterozygous for that antigen, both when unstimulated and following cytokine stimulation. Cell activation is an important consideration in the assessment of transplant risk and may help progress towards understanding why rejection does not always occur in the presence of significant donor specific antibody. This data also confirms guidelines for transplantation, which recommend doubling the specific antibody level when considering immunological risk for homozygous donors.
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Affiliation(s)
- B Sean Carey
- Histocompatibility and Immunogenetics, Combined Laboratory, Derriford Hospital, Plymouth, United Kingdom
| | - Kay V Poulton
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Anthony Poles
- Histocompatibility and Immunogenetics, Combined Laboratory, Derriford Hospital, Plymouth, United Kingdom
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19
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23rd Nantes Actualités Transplantation: "Genomics and Immunogenetics of Kidney and Inflammatory Diseases-Lessons for Transplantation". Transplantation 2019; 103:857-861. [PMID: 30399125 DOI: 10.1097/tp.0000000000002517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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20
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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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Tavares MG, Cristelli MP, Ivani de Paula M, Viana L, Felipe CR, Proença H, Aguiar W, Wagner Santos D, Tedesco‐Silva Junior H, Medina Pestana JO. Early hospital readmission after kidney transplantation under a public health care system. Clin Transplant 2019; 33:e13467. [DOI: 10.1111/ctr.13467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 11/27/2018] [Accepted: 12/02/2018] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Mayara Ivani de Paula
- Nephrology Division, Hospital do Rim Federal University of São Paulo São Paulo Brazil
| | - Laila Viana
- Nephrology Division, Hospital do Rim Federal University of São Paulo São Paulo Brazil
| | - Claudia Rosso Felipe
- Nephrology Division, Hospital do Rim Federal University of São Paulo São Paulo Brazil
| | - Henrique Proença
- Nephrology Division, Hospital do Rim Federal University of São Paulo São Paulo Brazil
| | - Wilson Aguiar
- Nephrology Division, Hospital do Rim Federal University of São Paulo São Paulo Brazil
| | - Daniel Wagner Santos
- Nephrology Division, Hospital do Rim Federal University of São Paulo São Paulo Brazil
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22
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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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23
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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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24
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The Humoral Theory of Transplantation: Epitope Analysis and the Pathogenicity of HLA Antibodies. J Immunol Res 2016; 2016:5197396. [PMID: 28070526 PMCID: PMC5192322 DOI: 10.1155/2016/5197396] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/17/2016] [Indexed: 01/30/2023] Open
Abstract
Central to the humoral theory of transplantation is production of antibodies by the recipient against mismatched HLA antigens in the donor organ. Not all mismatches result in antibody production, however, and not all antibodies are pathogenic. Serologic HLA matching has been the standard for solid organ allocation algorithms in current use. Antibodies do not recognize whole HLA molecules but rather polymorphic residues on the surface, called epitopes, which may be shared by multiple serologic HLA antigens. Data are accumulating that epitope analysis may be a better way to determine organ compatibility as well as the potential immunogenicity of given HLA mismatches. Determination of the pathogenicity of alloantibodies is evolving. Potential features include antibody strength (as assessed by antibody titer or, more commonly and inappropriately, mean fluorescence intensity) and ability to fix complement (in vitro by C1q or C3d assay or by IgG subclass analysis). Technical issues with the use of solid phase assays are also of prime importance, such as denaturation of HLA antigens and manufacturing and laboratory variability. Questions and controversies remain, and here we review new relevant data.
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