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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: 1] [Impact Index Per Article: 0.3] [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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2
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Kumar S, Doss SA, Jacob S, T Valson A, Alexander S, David VG, Varughese S, Daniel D. Association of prior sensitizing events with anti-human leukocyte antigen antibodies: An analysis of renal transplant recipients in a tertiary care centre in South India. Transfus Apher Sci 2020; 59:102808. [PMID: 32444280 DOI: 10.1016/j.transci.2020.102808] [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: 02/06/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
Traditionally, sensitizing events such as previous pregnancies, previous transfusions and prior transplants result in the production of anti-Human Leukocyte Antigen (HLA) antibodies. However, it has been observed that, anti-HLA antibodies have been detected in many patients with no prior history of sensitizing events. This retrospective study analysed the most recent 100 consecutive Single Antigen Bead (SAB) assay results performed on 100 patients. The SAB assay is used routinely to detect anti-HLA antibodies in transplant recipients. Results of the SAB assay were analyzed and subsequently studied to see if a correlation existed between sensitizing events, the type of events and presence of antibody. Analysis showed that 77% (77/100) had anti-HLA antibodies. 61 out of 100 patients had prior sensitizing events while the remaining 39 had none. Both these groups showed an almost equal percent of patients with anti-HLA antibodies 77% (47/61) and 76.9% (30/39) respectively. A single sensitizing event was seen in 54.1% (33/61) patients including previous transfusions in 29.5% (18/61), pregnancies in 11.4% (7/61) and prior transplant in 13.1% (8/61). Our study suggests that irrespective of whether patients have prior sensitizing events or not, patients run the risks of alloimmunization, and therefore appropriate screening tests should be included in the pre-transplant compatibility algorithm.
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Affiliation(s)
- Snehil Kumar
- Department of Transfusion Medicine and Immunohaematology, 5th Floor, ASHA Building, Christian Medical College, Vellore, Tamil Nadu, India.
| | - Sam Arul Doss
- Department of Transfusion Medicine and Immunohaematology, 5th Floor, ASHA Building, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shibu Jacob
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anna T Valson
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Suceena Alexander
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vinoi George David
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dolly Daniel
- Department of Transfusion Medicine and Immunohaematology, 5th Floor, ASHA Building, Christian Medical College, Vellore, Tamil Nadu, India
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3
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Minucci PB, Resse M, Sabia C, Esposito A, De Iorio G, Napoli C. Anti-HLA Antibodies Testing on Solid Phase: Comparative Evaluation of Different Kit Vendors Through Luminex Technology. EXP CLIN TRANSPLANT 2017; 15:636-640. [PMID: 28585912 DOI: 10.6002/ect.2016.0199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES For decades, the detection of anti-HLA antibodies in candidates for solid-organ transplant has been performed with the traditional complement-dependent cytotoxicity method; this assay has been then integrated with the introduction of solid-phase assays. Over the past 20 years, the Luminex assay has become the most widely used in clinical laboratories due to both increased sensitivity and specificity versus enzyme-linked immunosorbent assay. However, even the Luminex technique has shown some critical issues, and choosing the most reliable method still remains challenging. In this study, we verified the concordance of the results obtained in detecting anti-HLA antibodies with 2 kit vendors that provide reagents for the Luminex platform. MATERIALS AND METHODS We used 314 serum samples from patients on wait lists for solid-organ transplant. Sera were tested with LABScreen Mixed-LSM12 (One Lambda-Thermo Fisher, Canoga Park, CA, USA) and LIFECODES LifeScreen Deluxe-LMX (Gen-Probe-Immucor, Stanford, CT, USA),which we indicated as vendor A and vendor B, respectively. Anti-HLA class I and class II antibody analyses were conducted by verifying the concordance of the results with Cohen kappa coefficient statistics and confidence interval. RESULTS The kappa coefficient statistics showed "substantial" reliability for class I (0.61; confidence interval, 0.50-0.73) and "moderate" reliability for class II (0.56; confidence interval, 0.43-0.69). There were no considerable differences in results between the 2 kits regarding overall assignment of negativity or positivity of a sample. Discordant data between positive values for a test and negative for the other were found for samples with weak antibody positivity. CONCLUSIONS Some discordant data were probably attributable to several factors such as the composition of the kits, the antibody titer in the serum, whether sera were diluted, different washing methods, and type of plate used.
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Affiliation(s)
- Pellegrino Biagio Minucci
- From the U.O.C. Division of Immunohematology,Transfusion Medicine and Transplant Immunology, Regional Reference Laboratory of Transplant Immunology, Department of Internal Medicine and Specialistics, Azienda Ospedaliera Universitaria, University of Campania "Luigi Vanvitelli," Naples, Italy; and the Department of Biochemistry, Biophysics and General Pathology, University of Campania "Luigi Vanvitelli," Naples, Italy
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4
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Mehrotra S, Sharma RK, Mayya M, Gupta A, Prasad N, Kaul A, Bhadauria DS. Luminex Solid-Phase Crossmatch for De Novo Donor-Specific Antibodies in Living-Donor Related Transplants. EXP CLIN TRANSPLANT 2017; 15:394-399. [PMID: 28447925 DOI: 10.6002/ect.2016.0178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES There are no reports of de novo donor-specific antibody monitoring by a low-cost solid-phase crossmatch assay using donor lysate after renal transplant. MATERIALS AND METHODS We prospectively evaluated 121 complement-dependant cytotoxicity crossmatch-negative living-donor kidney transplant recipients for development of de novo donor-specific antibodies (class I and II HLA) by solid-phase crossmatch Luminex assay after transplant. RESULTS Of 121 recipients in our study group, 26 (21.5%) developed de novo donor-specific antibody within 3 months after transplant. Fifteen (58%) of these 26 recipients developed class II de novo donor-specific antibody, 8 patients (30%) developed class I, and 3 (12%) developed both class I and class II. Of the remaining 95 patients (79%) who did not develop de novo donor-specific antibody, 6 (33.3%) had antibody-mediated rejection with glomerulitis (2 with C4d-positive disease). Donor-specific antibody was detected by Luminex solid-phase crossmatch in 18 patients (5 with class I, 11 with class II, and 2 with both class I and II), all with no evidence of clinical rejection. Development of de novo donor-specific antibody detected by solid-phase crossmatch was associated with more acute rejection (31% in de novo donor-specific antibody-positive group versus 19% in the negative group). The positive group had more antibody-mediated rejection (75% of acute rejections), whereas only 33.3% of acute rejections in the negative group were antibody-mediated rejection. Of 12 patients with antibody-mediated rejection, 9 were C4d negative (75%) and were diagnosed by donor-specific antibody positivity detected by solid-phase cros?match testing and histologic findings. The use of donor lysate in solid-phase crossmatch assays is more economical than the single-antigen bead Luminex assay (per test cost of US $45.20 vs $403.20).
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Affiliation(s)
- Sonia Mehrotra
- From the Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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5
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Irure J, Asensio E, Rodrigo E, Romón Í, Gómez J, Arias M, López-Hoyos M, San Segundo D. Improvement in the definition of anti-HLA antibody profile in highly sensitized patients. PLoS One 2017; 12:e0171463. [PMID: 28158255 PMCID: PMC5291387 DOI: 10.1371/journal.pone.0171463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/20/2017] [Indexed: 11/20/2022] Open
Abstract
The definition of anti-HLA antibody profile in highly sensitized patients on a waiting list is crucial when virtual crossmatch is used in organ allocation systems, but also when used to identify the true deleterious anti-HLA antibodies. Here we propose different levels of risk based on the results of anti-HLA antibody testing in neat serum (N) and after sera dilution (DIL) and C1q test in 18 highly sensitized patients. This group was heterogeneous in terms of anti-HLA antibody titers and their ability to fix complement. After dilution, 15 out of 18 patients (83.3%) showed a reduction of positive bead counts whereas 4 patients showed a prozone effect and complement fixation was demonstrated. The high dilution of sera and ascertaining the complement fixation allow the accurate definition of risk anti-HLA antibody profiles in highly sensitized patients, as demonstrated in 5 of the sensitized patients who were transplanted.
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Affiliation(s)
- Juan Irure
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Esther Asensio
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Emilio Rodrigo
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Íñigo Romón
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Javier Gómez
- Pathology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Manuel Arias
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Marcos López-Hoyos
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - David San Segundo
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
- * E-mail:
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6
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Katalinić N, Fućak M, Crnić T, Ćurković M, Starčević A, Balen S. Pretransplantation monitoring of HLA antibodies by complement dependent cytotoxicity and Luminex-based assays. Wien Klin Wochenschr 2016; 129:33-37. [PMID: 27743177 DOI: 10.1007/s00508-016-1094-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/14/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The introduction of more sensitive techniques, such as Luminex® for HLA antibody screening of patients awaiting organ transplantation has resulted in a better understanding of transplantation immunology and improvements in clinical practice. OBJECTIVE The interpretation of the results obtained only by Luminex® can lead to inaccurate evaluation of a patient's antibody status and unjustified rejection of a potential organ donor. The aim of this study was to demonstrate the benefits of performing HLA antibody screening in the sera of patients on the waiting list for organ transplantation by two different assays, complement dependent cytotoxicity (CDC) and Luminex®. METHODS A retrospective analysis was performed on 563 pretransplant serum samples from 141 patients on the kidney transplantation waiting list in Rijeka, tested from March 2012 until March 2015. All samples were tested in parallel by the CDC assay and the Luminex®-based assay. RESULTS Out of the 563 samples tested 302 (53.7%) tested negative for HLA antibodies and 88 (15.6%) positive by both assays. From 173 (30.7%) samples with discordant results 149 (26.5%) were CDC negative and Luminex® positive, while 24 (4.3%) were CDC positive and Luminex® negative. Among the Luminex positive patients seven did not experience any immunizing events. CONCLUSION Evaluation of the HLA antibody status in patients on a waiting list for organ transplantation should be based on the results of the both CDC and Luminex® (or other sensitive) assays in accordance to information about patient's clinical status and exposure to immunizing events.
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Affiliation(s)
- Nataša Katalinić
- Tissue Typing Laboratory, Clinical Institute for Transfusion Medicine, Clinical Hospital Center Rijeka, Tome Strižića 3, 51 000, Rijeka, Croatia.
| | - Marina Fućak
- Tissue Typing Laboratory, Clinical Institute for Transfusion Medicine, Clinical Hospital Center Rijeka, Tome Strižića 3, 51 000, Rijeka, Croatia
| | - Tajana Crnić
- Tissue Typing Laboratory, Clinical Institute for Transfusion Medicine, Clinical Hospital Center Rijeka, Tome Strižića 3, 51 000, Rijeka, Croatia
| | - Milena Ćurković
- Tissue Typing Laboratory, Clinical Institute for Transfusion Medicine, Clinical Hospital Center Rijeka, Tome Strižića 3, 51 000, Rijeka, Croatia
| | - Alma Starčević
- Tissue Typing Laboratory, Clinical Institute for Transfusion Medicine, Clinical Hospital Center Rijeka, Tome Strižića 3, 51 000, Rijeka, Croatia
| | - Sanja Balen
- Tissue Typing Laboratory, Clinical Institute for Transfusion Medicine, Clinical Hospital Center Rijeka, Tome Strižića 3, 51 000, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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7
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Schinstock CA, Gandhi MJ, Stegall MD. Interpreting Anti-HLA Antibody Testing Data: A Practical Guide for Physicians. Transplantation 2016; 100:1619-28. [PMID: 27140516 PMCID: PMC4961613 DOI: 10.1097/tp.0000000000001203] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The development of sensitive methods for alloantibody detection has been a significant advance in clinical transplantation. However, the complexity of the data from solid phase and crossmatch assays has led to potential confusion about how to use the results for clinical decision making. The goal of this review is to provide a practical guide for transplant physicians for the interpretation of antibody data to supplement consultation with local tissue typing experts. Sources of variability in both the solid phase and crossmatch assay are discussed as are recent data regarding C1q binding antibodies and IgG subclass testing. Although definitive approaches to alloantibody testing are not possible with our current knowledge, we outline a pragmatic approach that we hope will enhance clinical management in this area.
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Affiliation(s)
- Carrie A Schinstock
- 1 William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN.2 Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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8
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Michel K, Santella R, Steers J, Sahajpal A, Downey FX, Thohan V, Oaks M. Many de novo donor-specific antibodies recognize β2 -microglobulin-free, but not intact HLA heterodimers. HLA 2016; 87:356-66. [PMID: 27060279 PMCID: PMC5071754 DOI: 10.1111/tan.12775] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/16/2016] [Accepted: 02/24/2016] [Indexed: 11/27/2022]
Abstract
Solid‐phase single antigen bead (SAB) assays are standard of care for detection and identification of donor‐specific antibody (DSA) in patients who receive solid organ transplantation (SOT). While several studies have documented the reproducibility and sensitivity of SAB testing for DSA, there are little data available concerning its specificity. This study describes the identification of antibodies to β2‐microglobulin‐free human leukocyte antigen (β2‐m‐fHLA) heavy chains on SAB arrays and provides a reassessment of the clinical relevance of DSA testing by this platform. Post‐transplant sera from 55 patients who were positive for de novo donor‐specific antibodies on a SAB solid‐phase immunoassay were tested under denaturing conditions in order to identify antibodies reactive with β2‐m‐fHLA or native HLA (nHLA). Antibodies to β2‐m‐fHLA were present in nearly half of patients being monitored in the post‐transplant period. The frequency of antibodies to β2‐m‐fHLA was similar among DSA and HLA antigens that were irrelevant to the transplant (non‐DSA). Among the seven patients with clinical or pathologic antibody‐mediated rejection (AMR), none had antibodies to β2‐m‐fHLA exclusively; thus, the clinical relevance of β2‐m‐fHLA is unclear. Our data suggests that SAB testing produces false positive reactions due to the presence of β2‐m‐fHLA and these can lead to inappropriate assignment of unacceptable antigens during transplant listing and possibly inaccurate identification of DSA in the post‐transplant period.
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Affiliation(s)
- K Michel
- Transplant Program, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - R Santella
- Transplant Institute, Avera McKennan Hospital and University System, Sioux Falls, SD, USA
| | - J Steers
- Transplant Institute, Avera McKennan Hospital and University System, Sioux Falls, SD, USA
| | - A Sahajpal
- Transplant Program, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - F X Downey
- Transplant Program, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - V Thohan
- Transplant Program, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - M Oaks
- Transplant Program, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
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Oh EJ, Park H, Park KU, Kang ES, Kim HS, Song EY. Interlaboratory Comparison of the Results of Lifecodes LSA Class I and Class II Single Antigen Kits for Human Leukocyte Antigen Antibody Detection. Ann Lab Med 2015; 35:321-8. [PMID: 25932440 PMCID: PMC4390700 DOI: 10.3343/alm.2015.35.3.321] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 11/29/2014] [Accepted: 02/07/2015] [Indexed: 12/02/2022] Open
Abstract
Background Although single antigen bead assays (SAB) are approved qualitative tests, the median fluorescence intensity (MFI) values obtained from SAB are frequently used in combination with quantitative significances for diagnostic purposes. To gauge the reproducibility of SAB results, we assessed the interlaboratory variability of MFI values using identical kits with reagents from the same lot and the manufacturer's protocol. Methods Six serum samples containing HLA-specific antibodies were analyzed at five laboratories by using Lifecodes LSA Class I and Class II SAB kits (Immucor, USA) from the same lot, according to the manufacturer's protocol. We analyzed the concordance of qualitative results according to distinct MFI cutoffs (1,000, 3,000, 5,000, and 10,000), and the correlation of quantitative MFI values obtained by the participating laboratories. The CV for MFI values were analyzed and grouped by mean MFI values from the five laboratories (<1,000; 1,000-2,999; 3,000-4,999; 5,000-9,999; and ≥10,000). Results The categorical results obtained from the five laboratories exhibited concordance rates of 96.0% and 97.2% for detection of HLA class I and class II antibodies, respectively. The Pearson correlation coefficients for MFI values of class I and class II antibodies were between 0.947-0.991 and 0.992-0.997, respectively. The median CVs for the MFI values among five laboratories in the lower MFI range (<1,000) were significantly higher than those for the other MFI ranges (all P<0.01). Conclusions Analysis of SAB performed in five laboratories using identical protocols and reagents from the same lot resulted in high levels of concordance and strong correlation of results.
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Affiliation(s)
- Eun-Jee Oh
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyewon Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun-Suk Kang
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyon-Suk Kim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Young Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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10
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Konvalinka A, Tinckam K. Utility of HLA Antibody Testing in Kidney Transplantation. J Am Soc Nephrol 2015; 26:1489-502. [PMID: 25804279 DOI: 10.1681/asn.2014080837] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
HLA antigens are polymorphic proteins expressed on donor kidney allograft endothelium and are critical targets for recipient immune recognition. HLA antibodies are risk factors for acute and chronic rejection and allograft loss. Solid-phase immunoassays for HLA antibody detection represent a major advance in sensitivity and specificity over cell-based methods and are widely used in organ allocation and pretransplant risk assessment. Post-transplant, development of de novo donor-specific HLA antibodies and/or increase in donor-specific antibodies from pretransplant levels are associated with adverse outcomes. Although single antigen bead assays have allowed sensitive detection of recipient HLA antibodies and their specificities, a number of interpretive considerations must be appreciated to understand test results in clinical and research contexts. This review, which is especially relevant for clinicians caring for transplant patients, discusses the technical aspects of single antigen bead assays, emphasizes their quantitative limitations, and explores the utility of HLA antibody testing in identifying and managing important pre- and post-transplant clinical outcomes.
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Affiliation(s)
| | - Kathryn Tinckam
- Department of Medicine, Division of Nephrology and Laboratory Medicine Program, HLA Laboratory, University Health Network, University of Toronto, Toronto, Ontario, Canada
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11
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Chen W, Kim JH, Zhang D, Lee KH, Cangelosi GA, Soelberg SD, Furlong CE, Chung JH, Shen AQ. Microfluidic one-step synthesis of alginate microspheres immobilized with antibodies. J R Soc Interface 2013; 10:20130566. [PMID: 23966617 DOI: 10.1098/rsif.2013.0566] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Micrometre- and submicrometre-size functionalized beads are frequently used to capture targets of interest from a biological sample for biological characterizations and disease diagnosis. The main challenge of the microbead-based assay is in the immobilization of probe molecules onto the microbead surfaces. In this paper, we report a versatile droplet microfluidics method to fabricate alginate microspheres while simultaneously immobilizing anti-Mycobacterium tuberculosis complex IgY and anti-Escherichia coli IgG antibodies primarily on the porous alginate carriers for specific binding and binding affinity tests. The binding affinity of antibodies is directly measured by fluorescence intensity of stained target bacteria on the microspheres. We demonstrate that the functionalized alginate microspheres yield specificity comparable with an enzyme-linked immunosorbent assay. The high surface area-to-volume ratio of the functionalized porous alginate microspheres improves the detection limit. By using the droplet microfluidics, we can easily modify the size and shape of alginate microspheres, and increase the concentration of functionalized alginate microspheres to further enhance binding kinetics and enable multiplexing.
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Affiliation(s)
- Wanyu Chen
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
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12
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Del Bello A, Congy-Jolivet N, Sallusto F, Guilbeau-Frugier C, Cardeau-Desangles I, Fort M, Esposito L, Guitard J, Cointault O, Lavayssière L, Nogier MB, Blancher A, Rostaing L, Kamar N. Donor-specific antibodies after ceasing immunosuppressive therapy, with or without an allograft nephrectomy. Clin J Am Soc Nephrol 2012; 7:1310-9. [PMID: 22626959 DOI: 10.2215/cjn.00260112] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Within the last few years, anti-human leukocyte antigen detection assays have significantly improved. This study asked, using the Luminex single-antigen assay, whether an allograft nephrectomy allowed donor-specific alloantibodies to appear that were not previously detected in the serum when the failed kidney was still in place. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS After losing the kidney allograft and stopping immunosuppressive therapy, the proportions of donor-specific alloantibodies and nondonor-specific alloantibodies were compared in patients who had (n=48; group I) and had not (n=21; group II) undergone an allograft nephrectomy. Allograft nephrectomies were performed at 150 days after kidney allograft loss, and the time between allograft nephrectomy and last follow-up was 538 ± 347 days. RESULTS At kidney allograft loss, donor-specific alloantibodies were detected in three group II patients (14.2%) and six group I patients (12.5%). At last follow-up, donor-specific alloantibodies were detected in 11 patients (52.4%) without and 39 patients (81%) with an allograft nephrectomy (P=0.02). Anti-human leukocyte antigen class I donor-specific alloantibodies were positive in 23.8% of group II and 77% of group I patients (P<0.001); anti-human leukocyte antigen class II donor-specific alloantibodies were positive in 42.8% of group II and 62.5% of group I patients. Independent predictive factors for developing donor-specific alloantibodies after losing kidney allograft and stopping immunosuppressants were number of anti-human leukocyte antigen A/B mismatches at transplantation (zero versus one or more) and allograft nephrectomy. CONCLUSIONS The development of donor-specific alloantibodies was significantly greater in patients with a failed kidney who had undergone an allograft nephrectomy compared with those patients who had not undergone allograft nephrectomy.
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Affiliation(s)
- Arnaud Del Bello
- Department of Nephrology, Dialysis and Organ Transplantation, Centre Hospitalier et Universitaire Rangueil, Toulouse, France
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