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Debyser T, Callemeyn J, Coemans M, Kerkhofs J, Koshy P, Kuypers D, Senev A, Tambur AR, Van Loon E, Wellekens K, Naesens M, Emonds MP. Sensitive HLA antibody testing and the risk of antibody-mediated rejection and graft failure. HLA 2024; 103:e15586. [PMID: 38932739 DOI: 10.1111/tan.15586] [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: 05/24/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
Solid phase detection and identification of HLA antibodies in kidney transplantation currently relies on single antigen bead (Luminex®) assays, which is more sensitive than the previously used enzyme-linked immunosorbent assays (ELISA). To evaluate the impact of more sensitive HLA testing on antibody-mediated rejection (AMR) occurrence and allograft survival, we analysed 1818 renal allograft recipients transplanted between March 2004 and May 2021. In 2008, solid phase testing switched from ELISA to Luminex. We included 393 (21.6%) transplantations before and 1425 (78.4%) transplantations after transition from ELISA- to Luminex-based testing. For this study, bio-banked ELISA era samples were tested retrospectively with Luminex. Significantly less pretransplant DSA were found in patients transplanted with pre-existing HLA antibodies in the Luminex (109/387) versus the ELISA period (43/90) (28% vs. 48%, p < 0.01). Throughout histological follow-up, 169 of 1818 (9.3%) patients developed AMR. After implementing Luminex-based testing, the rate of AMR significantly decreased (p = 0.003). However, incidence of graft failure did not significantly differ between both eras. In conclusion, less patients with pretransplant DSA were transplanted since the implementation of Luminex HLA testing. Transition from ELISA- to Luminex-based HLA testing was associated with a significant decrease in AMR occurrence post-transplantation. Since the decline of AMR did not translate into improved graft survival, Luminex-based testing has the added value of preventing low-risk AMR cases. Therefore, Luminex' high sensitivity must be balanced against waiting time for a suitable organ.
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Affiliation(s)
- Tim Debyser
- Department of Microbiology, Immunology and Transplantation, Nephrology and Kidney Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Jasper Callemeyn
- Department of Microbiology, Immunology and Transplantation, Nephrology and Kidney Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Maarten Coemans
- Department of Microbiology, Immunology and Transplantation, Nephrology and Kidney Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Johan Kerkhofs
- Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross Flanders, Mechelen, Belgium
| | - Priyanka Koshy
- Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Kuypers
- Department of Microbiology, Immunology and Transplantation, Nephrology and Kidney Transplantation Research Group, KU Leuven, Leuven, Belgium
- Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Aleksandar Senev
- Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross Flanders, Mechelen, Belgium
- Comprehensive Transplant Center, Northwestern University, Chicago, Illinois, USA
| | - Anat R Tambur
- Comprehensive Transplant Center, Northwestern University, Chicago, Illinois, USA
| | - Elisabet Van Loon
- Department of Microbiology, Immunology and Transplantation, Nephrology and Kidney Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Karolien Wellekens
- Department of Microbiology, Immunology and Transplantation, Nephrology and Kidney Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, Nephrology and Kidney Transplantation Research Group, KU Leuven, Leuven, Belgium
- Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Marie-Paule Emonds
- Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross Flanders, Mechelen, Belgium
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Ciftci HS, Oguz FS, Cinar CK, Izgi DK. The correlation of results of panel reactive antibody, identification, and single antigen beads in detection of anti-HLA antibodies: Istanbul Faculty of Medicine, tissue typing laboratory experience. Transpl Immunol 2023; 80:101891. [PMID: 37433395 DOI: 10.1016/j.trim.2023.101891] [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: 04/12/2023] [Revised: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND We have performed a retrospective analysis of anti-HLA class I MHC and class II MHC antibodies measured using a single antigen bead (SAB) assay and a panel reactive antibody (PRA) assay. MATERIAL AND METHODS A group of 256 patients with end-stage renal disease (ESRD) was tested for anti-HLA antibodies in the tissue typing laboratory between 2017 and 2020. In the cohort, the serum samples of patients waiting for transplantation were tested. Both the PRA and SAB tests of these patients were analyzed using the Luminex (Immucor) method. The threshold of positivity was accepted as median fluorescence intensities (MFI) ≥1000 for PRA screening and MFI ≥750 for SAB screening. RESULTS Overall, antibodies to HLA antigens were detected in 202 (78.9%) out of 256 patients in the PRA study. Antibodies against both class I/II antigens were detected only in 15.6% of these patients, whereas antibodies against only against class I HLA in 31.3% and only against class II HLA in 32.0%. By comparison, the SAB study found that 66.8% of patients were positive for HLA antigens. Furthermore, donor-specific antibodies (DSA) were detected in 52.0% of PRA-positive patients and 52.6% of SAB-positive patients. It was shown that 168 patients (83.2%) out of 202 PRA-positive patients were found to be SAB-positive. In addition, 51 patients negative in the SAB assay (94.4%) were also negative in the PRA assay. Statistical analysis established a significant correlation between the PRA and SAB positivity (p > 0.001). It was also shown that MFI ≥3000 PRA positivity for class I HLA antigens (p = 0.049) and MFI ≥5000 PRA positivity for class II antigens (p < 0.001) correlated with the SAB positivity in patients. CONCLUSION Our results showed the importance of both PRA and SAB assays to define the status of sensitization in patients.
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Affiliation(s)
- Hayriye Senturk Ciftci
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Biology, Tissue Typing Laboratory, Istanbul-Turkiye, Millet street Fatih, Istanbul 34093, Turkey.
| | - Fatma Savran Oguz
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Biology, Tissue Typing Laboratory, Istanbul-Turkiye, Millet street Fatih, Istanbul 34093, Turkey
| | - Cigdem Kekik Cinar
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Biology, Tissue Typing Laboratory, Istanbul-Turkiye, Millet street Fatih, Istanbul 34093, Turkey.
| | - Demet Kivanc Izgi
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Biology, Tissue Typing Laboratory, Istanbul-Turkiye, Millet street Fatih, Istanbul 34093, Turkey; Istanbul University, Institute of Health Sciences/Medical Biology, Istanbul, Turkiye
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3
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Rosser C, Sage D. Approaches for the characterization of clinically relevant pre-transplant human leucocyte antigen (HLA) antibodies in solid organ transplant patients. Int J Immunogenet 2021; 48:385-402. [PMID: 34346180 DOI: 10.1111/iji.12552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/30/2021] [Accepted: 07/22/2021] [Indexed: 11/27/2022]
Abstract
The avoidance of antibody-mediated rejection (AMR) attributed to human leucocyte antigen (HLA) antibody incompatibility remains an essential function of clinical Histocompatibility and Immunogenetics (H&I) laboratories who are supporting solid organ transplantation. Developments in HLA antibody identification assays over the past thirty years have greatly reduced unexpected positive cellular crossmatches and improved solid organ transplant outcomes. For sensitized patients, the decision to register unacceptable HLA antigen mismatches is often heavily influenced by results from solid phase antibody assays, particularly the Luminex® Single Antigen Bead (SAB) assays, although the clinical relevance of antibodies identified solely by these assays remains unclear. As such, the identification of non-clinically relevant antibodies may proportionally increase the number of unacceptable transplant mismatches registered, with an associated increase in waiting time for a compatible organ. We reflect on the clinical relevance of antibodies identified solely by the Luminex SAB® assays and consider whether the application of additional assays and/or tools could further develop our ability to define the clinical relevance of antibodies identified in patient sera. Improvements in this area would assist equity of access to a compatible transplant for highly sensitized patients awaiting a solid organ transplant.
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Affiliation(s)
- Carla Rosser
- NHS Blood and Transplant (Tooting), Histocompatibility and Immunogenetics, London, UK
| | - Deborah Sage
- NHS Blood and Transplant (Tooting), Histocompatibility and Immunogenetics, London, UK
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Teixeira AC, Távora F, de Deus E Silva MLF, Prado RMG, de Matos Esmeraldo R, de Sandes-Freitas TV. The immunohistochemical expression of von Willebrand factor, T-cadherin, and Caveolin-1 is increased in kidney allograft biopsies with antibody-mediated injury. Clin Exp Nephrol 2020; 25:305-314. [PMID: 33242156 DOI: 10.1007/s10157-020-01994-6] [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: 06/23/2020] [Accepted: 11/08/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND There are only a few reports evaluating the applicability of endothelial-damage markers analysis by immunohistochemistry (IHC) in kidney allograft samples. This study analyzed the expression of Caveolin-1 (Cav), von Willebrand factor (Vwf), and T-cadherin (Cad) in kidney biopsies and their association with antibody-mediated injury. METHODS In this retrospective study, 114 cases with antibody-mediated changes (Banff, 2020) and 72 with interstitial fibrosis/tubular atrophy were selected. IHC for Cav, Vwf and Cad was performed and evaluated according to their qualitative expression in peritubular capillaries. The cases were grouped according to the presence of microvascular inflammation (MVI), donor-specific antibodies (DSA), C4d positivity and antibody-mediated rejection (AMR). A level of significance < 0.05 was adopted. RESULTS Vwf expression was associated with MVI (p < 0.001), DSA (p = 0.016), C4d (p < 0.001) and AMR (p < 0.001), and was higher in DSA+/C4d+ cases despite MVI (p < 0.001). The expression of Cad correlated with MVI (p = 0.015), C4d (p = 0.005) and AMR (p = < 0.001). Cad was more expressed in chronic AMR compared with acute/active cases (p = 0.001). Cav expression was associated with MVI (p = 0.029) and AMR (p = 0.016) and was also higher in chronic AMR (p = 0.049). A combined score of Vwf and Cad was higher in AMR when compared with C4d without rejection and IF/TA cases (p < 0.001). CONCLUSION Vwf, Cad and Cav expression shows association with antibody-mediated injury and may be helpful to support AMR diagnosis.
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Affiliation(s)
- André Costa Teixeira
- Medical Sciences Postgraduation Program, Department of Clinical Medicine, Faculty of Medicine of the Federal University of Ceará, Monsenhor Furtado St, s/n, Fortaleza, CE, 60430-275, Brazil. .,ARGOS Patologia, 5753 Santos Dumont av, Room 1604, Office Tower, Fortaleza, Ceará, 60175047, Brazil.
| | - Fábio Távora
- Medical Sciences Postgraduation Program, Department of Clinical Medicine, Faculty of Medicine of the Federal University of Ceará, Monsenhor Furtado St, s/n, Fortaleza, CE, 60430-275, Brazil.,ARGOS Patologia, 5753 Santos Dumont av, Room 1604, Office Tower, Fortaleza, Ceará, 60175047, Brazil
| | | | - Renan Martins Gomes Prado
- Faculty of Medicine of State University of Ceará, 1700 Silas Munguba St, Itaperi, Fortaleza, CE, 60441-750, Brazil
| | - Ronaldo de Matos Esmeraldo
- Division of Transplantation, General Hospital of Fortaleza, 900 Ávila Goulart St, Papicu, Fortaleza, CE, 60165-160, Brazil
| | - Tainá Veras de Sandes-Freitas
- Medical Sciences Postgraduation Program, Department of Clinical Medicine, Faculty of Medicine of the Federal University of Ceará, Monsenhor Furtado St, s/n, Fortaleza, CE, 60430-275, Brazil.,Division of Transplantation, General Hospital of Fortaleza, 900 Ávila Goulart St, Papicu, Fortaleza, CE, 60165-160, Brazil
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5
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Morath C, Döhler B, Kälble F, Pego da Silva L, Echterdiek F, Schwenger V, Živčić-Ćosić S, Katalinić N, Kuypers D, Benöhr P, Haubitz M, Ziemann M, Nitschke M, Emmerich F, Pisarski P, Karakizlis H, Weimer R, Ruhenstroth A, Scherer S, Tran TH, Mehrabi A, Zeier M, Süsal C. Pre-transplant HLA Antibodies and Delayed Graft Function in the Current Era of Kidney Transplantation. Front Immunol 2020; 11:1886. [PMID: 32983110 PMCID: PMC7489336 DOI: 10.3389/fimmu.2020.01886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/13/2020] [Indexed: 12/04/2022] Open
Abstract
Delayed graft function (DGF) occurs in a significant proportion of deceased donor kidney transplant recipients and was associated with graft injury and inferior clinical outcome. The aim of the present multi-center study was to identify the immunological and non-immunological predictors of DGF and to determine its influence on outcome in the presence and absence of human leukocyte antigen (HLA) antibodies. 1,724 patients who received a deceased donor kidney transplant during 2008–2017 and on whom a pre-transplant serum sample was available were studied. Graft survival during the first 3 post-transplant years was analyzed by multivariable Cox regression. Pre-transplant predictors of DGF and influence of DGF and pre-transplant HLA antibodies on biopsy-proven rejections in the first 3 post-transplant months were determined by multivariable logistic regression. Donor age ≥50 years, simultaneous pre-transplant presence of HLA class I and II antibodies, diabetes mellitus as cause of end-stage renal disease, cold ischemia time ≥18 h, and time on dialysis >5 years were associated with increased risk of DGF, while the risk was reduced if gender of donor or recipient was female or the reason for death of donor was trauma. DGF alone doubled the risk for graft loss, more due to impaired death-censored graft than patient survival. In DGF patients, the risk of death-censored graft loss increased further if HLA antibodies (hazard ratio HR=4.75, P < 0.001) or donor-specific HLA antibodies (DSA, HR=7.39, P < 0.001) were present pre-transplant. In the presence of HLA antibodies or DSA, the incidence of biopsy-proven rejections, including antibody-mediated rejections, increased significantly in patients with as well as without DGF. Recipients without DGF and without biopsy-proven rejections during the first 3 months had the highest fraction of patients with good kidney function at year 1, whereas patients with both DGF and rejection showed the lowest rate of good kidney function, especially when organs from ≥65-year-old donors were used. In this new era of transplantation, besides non-immunological factors, also the pre-transplant presence of HLA class I and II antibodies increase the risk of DGF. Measures to prevent the strong negative impact of DGF on outcome are necessary, especially during organ allocation for presensitized patients.
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Affiliation(s)
- Christian Morath
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Kälble
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Fabian Echterdiek
- Department of Nephrology and Autoimmune Diseases, Transplantation Center, Klinikum Stuttgart, Stuttgart, Germany
| | - Vedat Schwenger
- Department of Nephrology and Autoimmune Diseases, Transplantation Center, Klinikum Stuttgart, Stuttgart, Germany
| | - Stela Živčić-Ćosić
- Department of Nephrology, Dialysis and Kidney Transplantation, Department of Internal Medicine, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Nataša Katalinić
- Tissue Typing Laboratory, Clinical Institute of Transfusion Medicine, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Dirk Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Peter Benöhr
- Department of Nephrology and Hypertension, Center for Internal Medicine and Medical Clinic III, Klinikum Fulda, Fulda, Germany
| | - Marion Haubitz
- Department of Nephrology and Hypertension, Center for Internal Medicine and Medical Clinic III, Klinikum Fulda, Fulda, Germany
| | - Malte Ziemann
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Martin Nitschke
- Medical Clinic 1, Transplantation Center, University of Lübeck, Lübeck, Germany
| | - Florian Emmerich
- Institute for Transfusion Medicine and Gene Therapy, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Przemyslaw Pisarski
- Department of General and Digestive Surgery, University Medical Centre Freiburg, Freiburg, Germany
| | - Hristos Karakizlis
- Department of Internal Medicine, University of Giessen, Giessen, Germany
| | - Rolf Weimer
- Department of Internal Medicine, University of Giessen, Giessen, Germany
| | - Andrea Ruhenstroth
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Scherer
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thuong Hien Tran
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Caner Süsal
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
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6
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Thammanichanond D, Sukhumvat S, Tammakorn C, Siriyotha S, Kantachuvesiri S. Comparison Between Phenotypic Bead Assay and Single Antigen Bead Assay for Determining Specificity of HLA Antibodies in Kidney Transplant Waiting List. Transplant Proc 2020; 52:1675-1679. [PMID: 32448666 DOI: 10.1016/j.transproceed.2020.01.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 01/22/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The determination of unacceptable antigens in patients on kidney transplant waiting list is a critical laboratory investigation in sensitized patients. The Luminex single antigen bead (SAB) assay has high sensitivity and accuracy. However, several countries have not yet implemented SAB testing for waitlisted patients because of limited financial resources. In Thailand, specificities of HLA antibodies are identified by using a phenotypic bead assay. The aim of this study was to evaluate the performance of the phenotypic bead assay for determining HLA antibody specificities when compared with the SAB assay. METHODS A total of 254 sera from patients awaiting kidney transplantation were included. Of 254 sera, 206 and 171 were positive for HLA class I and II antibodies, respectively. Antibody specificities of sera that were tested with both phenotypic and SAB assay were analyzed. The performances of the phenotypic bead assay were compared with those of the SAB assay as the gold standard by using estimation of pooling sensitivity, specificity, and accuracy. RESULTS The sensitivity, specificity, and accuracy of the phenotypic bead assay for determining HLA class I antibodies was 53.9%, 93.0%, and 78.1%, respectively. The sensitivity, specificity, and accuracy of the phenotypic bead assay for determining HLA class II antibodies were 57.3%, 94.9%, and 81.4% respectively. CONCLUSION In waitlisted kidney transplant patients, the phenotypic bead assay had high specificity and moderate accuracy when compared with the SAB assay. However, the low sensitivity of the test suggests that the use of the phenotypic assay for determining HLA specificities should be applied with caution in sensitized patients.
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Affiliation(s)
- Duangtawan Thammanichanond
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Sireewan Sukhumvat
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chutima Tammakorn
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sukanya Siriyotha
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Surasak Kantachuvesiri
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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7
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Lucisano G, Thiruvengadam S, Hassan S, Gueret-Wardle A, Brookes P, Santos-Nunez E, Willicombe M. Donor-specific antibodies detected by single antigen beads alone can help risk stratify patients undergoing retransplantation across a repeat HLA mismatch. Am J Transplant 2020; 20:441-450. [PMID: 31529621 DOI: 10.1111/ajt.15595] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/25/2019] [Accepted: 08/27/2019] [Indexed: 01/25/2023]
Abstract
Whether reexposure to mismatched HLA antigens (RMM) in the setting of a negative crossmatch is associated with increased immunological risk remains an area of uncertainty. This is due to evidence derived predominantly from registry data, which lacks comprehensive information on alloantibody and rejection. In this study, we analyze the impact of low-level preformed donor-specific antibodies (DSA) against an RMM on transplant outcomes. From 1988 consecutive renal transplant recipients, we analyzed 179 patients undergoing retransplantation, of whom 55 had a RMM. All patients were crossmatch negative and preformed DSA were detected by single antigen beads alone. Multivariate analysis revealed that patients with preformed DSA against an RMM were independently at risk of antibody-mediated rejection (HR 8.70 [3.42-22.10], P < .0001) and death-censored allograft loss (HR 3.08 [1.17-8.14], P = .023). In addition, prior transplant nephrectomy (HR 2.04 [1.00-4.17], P = .0495) was also associated with allograft failure, whereas receiving a retransplant that was matched at HLA class II was associated with a favorable outcome (HR 0.37 [0.14-0.99], P = .047). In the absence of preformed DSA, an RMM was not associated with de novo DSA development, rejection, or allograft loss. In conclusion, an RMM portends increased immunological risk only in the presence of a preformed DSA in patients undergoing retransplantation.
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Affiliation(s)
- Gaetano Lucisano
- Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Srivathsan Thiruvengadam
- Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Sevda Hassan
- Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Alexander Gueret-Wardle
- Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Paul Brookes
- Histocompatibility and Immunogenetics, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Eva Santos-Nunez
- Histocompatibility and Immunogenetics, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Michelle Willicombe
- Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.,Centre for Inflammatory Disease, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London, UK
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8
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Wehmeier C, Hönger G, Schaub S. Caveats of HLA antibody detection by solid‐phase assays. Transpl Int 2019; 33:18-29. [DOI: 10.1111/tri.13484] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/26/2019] [Accepted: 07/24/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Caroline Wehmeier
- Clinic for Transplantation Immunology and Nephrology University Hospital Basel Basel Switzerland
| | - Gideon Hönger
- Clinic for Transplantation Immunology and Nephrology University Hospital Basel Basel Switzerland
- Transplantation Immunology Department of Biomedicine University of Basel Basel Switzerland
- HLA‐Diagnostic and Immunogenetics Department of Laboratory Medicine University Hospital Basel Basel Switzerland
| | - Stefan Schaub
- Clinic for Transplantation Immunology and Nephrology University Hospital Basel Basel Switzerland
- Transplantation Immunology Department of Biomedicine University of Basel Basel Switzerland
- HLA‐Diagnostic and Immunogenetics Department of Laboratory Medicine University Hospital Basel Basel Switzerland
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9
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Navas A, Molina J, Agüera ML, Guler I, Jurado A, Rodríguez-Benot A, Alonso C, Solana R. Characterization of the C1q-Binding Ability and the IgG1-4 Subclass Profile of Preformed Anti-HLA Antibodies by Solid-Phase Assays. Front Immunol 2019; 10:1712. [PMID: 31428086 PMCID: PMC6687874 DOI: 10.3389/fimmu.2019.01712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 07/08/2019] [Indexed: 12/11/2022] Open
Abstract
Humoral alloimmunity, particularly that triggered by preformed antibodies against human leukocyte antigens (HLA), is associated with an increased prevalence of rejection and reduced transplant survival. The high sensitivity of solid phase assays, based on microbeads coated with single antigens (SAB), consolidated them as the gold-standard method to characterize anti-HLA antibodies, ensuring a successful allograft allocation. Mean fluorescence intensity (MFI) provided by SAB is regularly used to stratify the immunological risk, assuming it as a reliable estimation of the antibody-level, but it is often limited by artifacts. Beyond MFI, other properties, such as the complement-binding ability or the IgG1-4 subclass profile have been examined to more accurately define the clinical relevance of antibodies and clarify their functional properties. However, there are still unresolved issues. Neat serum-samples from 20 highly-sensitized patients were analyzed by SAB-panIgG, SAB-IgG1-4 subclass and SAB-C1q assays. All 1:16 diluted serum-samples were additionally analyzed by SAB-panIgG and SAB-IgG1-4 subclass assays. A total of 1,285 anti-HLA antibodies were identified as positive, 473 (36.8%) of which were C1q-binding. As expected, serum-dilution enhanced the correlation between the C1q-binding ability and the antibody-strength, measured as the MFI (rneat = 0.248 vs. rdiluted = 0.817). SAB-subclass assay revealed at least one IgG1-4 subclass in 1,012 (78.8%) positive antibody-specificities. Among them, strong complement-binding subclasses, mainly IgG1, were particularly frequent (98.9%) and no differences were found between C1q- and non-C1q-binding antibodies regarding their presence (99.4 vs. 98.5%; p = 0.193). In contrast, weak or non-C1q-binding subclasses (IgG2/IgG4) were more commonly detected in C1q-binding antibodies (78.9 vs. 38.6%; p < 0.001). Interestingly, a strong association was found between the C1q-binding ability and the IgG1 strength (rIgG1dil = 0.796). Though lower, the correlation between the IgG2 strength and the C1q-binding ability was also strong (rIgG2dil = 0.758), being both subclasses closely related (rIgG1−IgG2 = 0.817). We did not find any correlation with the C1q-binding ability considering the remaining subclasses. In conclusion, we demonstrate that a particular profile of IgG subclasses (IgG1/IgG3) itself does not determine at all the ability to bind complement of anti-HLA antibodies assessed by SAB-C1q assay. It is the IgG subclass strength, mainly of IgG1, which usually appears in combination with IgG2, that best correlates with it.
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Affiliation(s)
- Ana Navas
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Department of Immunology and Allergy, Reina Sofia University Hospital, Cordoba, Spain
| | - Juan Molina
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Department of Immunology and Allergy, Reina Sofia University Hospital, Cordoba, Spain
| | - María-Luisa Agüera
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Department of Nephrology, Reina Sofia University Hospital, Cordoba, Spain
| | - Ipek Guler
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Aurora Jurado
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Department of Immunology and Allergy, Reina Sofia University Hospital, Cordoba, Spain
| | - Alberto Rodríguez-Benot
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Department of Nephrology, Reina Sofia University Hospital, Cordoba, Spain
| | - Corona Alonso
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Department of Immunology and Allergy, Reina Sofia University Hospital, Cordoba, Spain
| | - Rafael Solana
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Department of Immunology and Allergy, Reina Sofia University Hospital, Cordoba, Spain
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10
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Lima BA, Alves H. Portuguese calculated panel reactive antibodies online estimator. HLA 2019; 93:445-450. [PMID: 30838808 DOI: 10.1111/tan.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/17/2019] [Accepted: 03/01/2019] [Indexed: 11/29/2022]
Abstract
Calculated panel reactive antibodies (CPRA) is a sensitization measure used to classify and prioritize transplant candidates in different kidney transplant allocation systems. CPRA is based on identification of HLA unacceptable on potential organ donors making a transplant candidate ineligible for transplantation. Here, we present a CPRA online estimator based on HLA allelic and haplotypic frequencies from Portuguese donors. We also compare the values we obtained from our CPRA estimator (Portuguese [PT]-CPRA) against CPRA values obtained from: Eurotransplant virtual PRA calculator (ET-CPRA); Canadian CPRA calculator (Canadian [CN]-CPRA) and Organ Procurement and Transplantation Network CPRA calculator (United States [US]-CPRA). When we analyzed correlations between CPRA values obtained from pairs of calculators, we observed that they are significantly and highly correlated. Bland-Altman plots for the comparison between PT-CPRA calculator against the other calculators, show higher differences between PT and CN than between PT and ET and PT and US. Also, the lowest value for Lin's concordance coefficient was obtained for the comparison between PT and CN calculators. CPRA values reliability depend on donors' pool from which it is calculated and it is crucial for classify correctly highly sensitized patients. A CPRA calculator must use donors' HLA frequencies similar from those who would be actual organ donors.
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Affiliation(s)
- Bruno A Lima
- Data Science Department, Oficina de Bioestatistica, Vilar Formoso, Portugal
| | - Helena Alves
- Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Instituto Nacional de Saúde Dr. Ricardo Jorge, Vilar Formoso, Portugal
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11
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McCaughan J, Xu Q, Tinckam K. Detecting donor-specific antibodies: the importance of sorting the wheat from the chaff. Hepatobiliary Surg Nutr 2019; 8:37-52. [PMID: 30881964 DOI: 10.21037/hbsn.2019.01.01] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Human leukocyte antigen (HLA) compatibility is very important for successful transplantation of solid organs. In this paper, we focused on the humoral arm of immunity in the clinical setting of organ transplantation: how HLA antibodies develop, how they can be detected, and what they can do to injure organ transplants. Specifically, we explore the technical perspectives of detecting donor-specific antibodies (DSA) in HLA laboratories, and use real-life clinical cases to explain the principles. Currently there are many tools in our HLA antibody detection toolbox: conventional cytotoxicity cross match, flow cross match, and solid phase assays using beads conjugated with single or multiple HLA antigens. Single antigen bead (SAB) assay is the most sensitive tool available for detecting HLA antibodies and assessing the immunological risk for organ transplant. However, there are intrinsic limitations to solid-phase assays and they are prone to both false negativity and importantly, false positivity. Denatured antigens on single antigen beads might be the most prominent source of false positive reactivity, and may have been underestimated by many HLA experts. No single assay is perfect and therefore multiple methods, including the less sensitive assays, should be employed to determine the clinical relevance of detected HLA antibodies. Thoughtful process, including knowledge of HLA systems, cross reactivity, epitopes, and the patient's clinical history should be employed to correctly interpret data. The clinical team should work closely with HLA laboratories to ensure accurate interpretation of information and optimal management of patients before and after organ transplantation.
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Affiliation(s)
- Jennifer McCaughan
- Regional Histocompatibility Laboratory, University Health Network, Toronto, ON, Canada
| | - Qingyong Xu
- Transplant Immunology Lab, London Health Sciences Centre, London, ON, Canada
| | - Kathryn Tinckam
- Regional Histocompatibility Laboratory, University Health Network, Toronto, ON, Canada
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12
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Al Attas R, Alzahrani M, Al-Otaibi AS, Lopez R, Liacini A, Alzahrani S, Ajlan K, Abduladheem D, Kebasi S, Harbi H. Discrepant Antibody Testing Results: Which One to Believe? Transplant Proc 2019; 51:497-503. [PMID: 30879576 DOI: 10.1016/j.transproceed.2019.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The impact of solid-phase immunoassay for HLA antibody detection on the field of transplantation has been extremely significant by providing the most sensitive and precise method for characterization of HLA antibodies. However, despite all the benefits, technical limitations and inherent artifacts represent significant challenges, particularly with Luminex-based single-antigen bead (SAB) assay. Discordant results between antibody detection (screening assay) and identification (SAB) is not uncommon. Positive SAB assay in the context of negative screening testing is well documented and attributed to altered tertiary structure of HLA molecules exposing new epitopes or detection of naturally occurring antibodies. However, there are few reports that addressed the opposite scenario when negative SAB appeared in the context of positive screening assay. In such discrepant results, unmissed HLA antibody has to be excluded with certainty by other tests; however, with the availability of variable assays it may be difficult to choose the best combinations that clarify discrepancy without adding more confusion. Here we describe the results of correlation between 2 antibody screening solid-phase immunoassays (LABScreen Mixed using Luminex and FlowPRA Screen) on conventional flow cytometry and compare their outcomes with SAB and crossmatch results.
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Affiliation(s)
- Rabab Al Attas
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia.
| | - Mariam Alzahrani
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Ahmed S Al-Otaibi
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Ricardo Lopez
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Abdelhamid Liacini
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Saber Alzahrani
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Kenana Ajlan
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Dalal Abduladheem
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Shaima Kebasi
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Hassan Harbi
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
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13
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How the definition of acceptable antigens and epitope analysis can facilitate transplantation of highly sensitized patients with excellent long-term graft survival. Curr Opin Organ Transplant 2018; 23:493-499. [DOI: 10.1097/mot.0000000000000545] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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14
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Analysis of Luminex-based Algorithms to Define Unacceptable HLA Antibodies in CDC-crossmatch Negative Kidney Transplant Recipients. Transplantation 2018; 102:969-977. [DOI: 10.1097/tp.0000000000002129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Evidence for an important role of both complement-binding and noncomplement-binding donor-specific antibodies in renal transplantation. Curr Opin Organ Transplant 2017; 21:433-40. [PMID: 27348472 DOI: 10.1097/mot.0000000000000324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW The review describes the current clinical relevance of circulating anti-human leukocyte antigen (anti-HLA) antibodies in kidney transplantation and discusses recent improvements in their characterization that provide new insights into the identification and management of important clinical outcomes. RECENT FINDINGS Recent studies addressing the relationships between donor-specific anti-HLA antibody (HLA-DSA) properties (i.e., their strength, complement-binding capacity, and IgG subclass composition) and allograft injury and survival have highlighted their relevance in the prediction of antibody-mediated injury and allograft loss. SUMMARY Antibody-mediated rejection is the leading cause of kidney allograft loss. Although considerable experimental and clinical evidence suggests a causal effect of circulating HLA-DSAs in antibody-mediated rejection and allograft failure, HLA-DSAs induce a wide spectrum of injuries to the allograft that illustrate the need to delineate the characteristics of HLA-DSAs that confer pathogenesis. Current risk stratification is based on HLA-DSA characteristics, including antibody specificity, HLA class, and strength. Recently, the complement-binding capacity of HLA-DSAs has been recognized as a clinically relevant marker for predicting pathogenicity and allograft loss. Emerging data also support a role for HLA-DSA IgG subclass composition in discriminating distinct patterns of antibody-mediated injury. This progress in our understanding of HLA-DSA pathogenicity provides new tools to stratify individual immunological risks. However, specific prospective studies addressing immunological risk stratification in large and unselected populations are required to define the clinical benefit and cost-effectiveness of such a comprehensive assessment of HLA-DSAs before implementation in current clinical practice.
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16
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Molina J, Navas A, Agüera ML, Rodelo-Haad C, Alonso C, Rodríguez-Benot A, Aljama P, Solana R. Impact of Preformed Donor-Specific Anti-Human Leukocyte Antigen Antibody C1q-Binding Ability on Kidney Allograft Outcome. Front Immunol 2017; 8:1310. [PMID: 29163462 PMCID: PMC5671504 DOI: 10.3389/fimmu.2017.01310] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/28/2017] [Indexed: 12/24/2022] Open
Abstract
The consolidation of single antigen beads (SAB-panIgG) assay in the detection of preformed anti-human leukocyte antigen (HLA) antibodies has improved transplantation success. However, its high sensitivity has limited the allograft allocation for sensitized patients, increasing their waiting time. A modification of the standard SAB-panIgG assay allows the detection of that subset of antibodies capable of binding C1q (SAB-C1q assay). However, the clinical usefulness of SAB-C1q assay for determining the unacceptable mismatches is under discussion. We retrospectively analyzed the impact of preformed donor-specific anti-HLA antibodies (DSA) according to the C1q-binding ability on allograft outcome, examining 389 single-kidney transplanted patients from deceased donors. Recipients with preformed C1q-binding DSA showed the lowest allograft survival up to 7 years (40.7%) compared to patients with preformed non-C1q-binding DSA (73.4%; p = 0.001) and without DSA (79.1%; p < 0.001). Allograft survival rate was similar between patients with preformed non-C1q-binding DSA and patients without preformed DSA (p = 0.403). Interestingly, among the high-mean fluorescence intensity DSA (≥10,000) population (n = 46), those patients whose DSA were further capable of binding C1q showed a poorer allograft outcome (38.4 vs. 68.9%; p = 0.041). Moreover, in our multivariate predictive model for assessing the risk of allograft loss, the presence of C1q-binding DSA (HR 4.012; CI 95% 2.326–6.919; p < 0.001) but not of non-C1q-binding DSA (HR 1.389; CI 95% 0.784–2.461; p = 0.260) remained an independent predictor after stratifying the DSA population according to the C1q-binding ability and adjusting the model for other pre-transplantation predictive factors including donor age, cold-ischemia time, and HLA-DR mismatches. In conclusion, the unacceptable mismatch definition according to the SAB-C1q assay would improve the risk stratification of allograft loss and increase the limited allograft allocation of highly sensitized patients, shortening their waiting time.
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Affiliation(s)
- Juan Molina
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Ana Navas
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - María-Luisa Agüera
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Department of Nephrology, Reina Sofia University Hospital, Cordoba, Spain
| | - Cristian Rodelo-Haad
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Corona Alonso
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Department of Allergy and Immunology, Reina Sofia University Hospital, Cordoba, Spain
| | - Alberto Rodríguez-Benot
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Department of Nephrology, Reina Sofia University Hospital, Cordoba, Spain
| | - Pedro Aljama
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Department of Nephrology, Reina Sofia University Hospital, Cordoba, Spain
| | - Rafael Solana
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Department of Immunology, Infanta Cristina University Hospital, Badajoz, Spain
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17
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Wenda S, Faé I, Fischer GF. An HLA-B7-specific antibody in an HLA-B*07
positive patient explained by a nonexpressed allele (HLA-B*07:181N
). HLA 2017; 90:32-35. [DOI: 10.1111/tan.13045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/15/2017] [Accepted: 03/22/2017] [Indexed: 11/29/2022]
Affiliation(s)
- S. Wenda
- Department for Blood Group Serology and Transfusion Medicine; Medical University of Vienna; Vienna Austria
| | - I. Faé
- Department for Blood Group Serology and Transfusion Medicine; Medical University of Vienna; Vienna Austria
| | - G. F. Fischer
- Department for Blood Group Serology and Transfusion Medicine; Medical University of Vienna; Vienna Austria
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18
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Repeated human leukocyte antigen mismatches in lung re-transplantation. Transpl Immunol 2017; 40:1-7. [DOI: 10.1016/j.trim.2016.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 11/20/2022]
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19
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Viglietti D, Loupy A, Vernerey D, Bentlejewski C, Gosset C, Aubert O, Duong van Huyen JP, Jouven X, Legendre C, Glotz D, Zeevi A, Lefaucheur C. Value of Donor-Specific Anti-HLA Antibody Monitoring and Characterization for Risk Stratification of Kidney Allograft Loss. J Am Soc Nephrol 2017; 28:702-715. [PMID: 27493255 PMCID: PMC5280026 DOI: 10.1681/asn.2016030368] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/29/2016] [Indexed: 11/03/2022] Open
Abstract
The diagnosis system for allograft loss lacks accurate individual risk stratification on the basis of donor-specific anti-HLA antibody (anti-HLA DSA) characterization. We investigated whether systematic monitoring of DSA with extensive characterization increases performance in predicting kidney allograft loss. This prospective study included 851 kidney recipients transplanted between 2008 and 2010 who were systematically screened for DSA at transplant, 1 and 2 years post-transplant, and the time of post-transplant clinical events. We assessed DSA characteristics and performed systematic allograft biopsies at the time of post-transplant serum evaluation. At transplant, 110 (12.9%) patients had DSAs; post-transplant screening identified 186 (21.9%) DSA-positive patients. Post-transplant DSA monitoring improved the prediction of allograft loss when added to a model that included traditional determinants of allograft loss (increase in c statistic from 0.67; 95% confidence interval [95% CI], 0.62 to 0.73 to 0.72; 95% CI, 0.67 to 0.77). Addition of DSA IgG3 positivity or C1q binding capacity increased discrimination performance of the traditional model at transplant and post-transplant. Compared with DSA mean fluorescence intensity, DSA IgG3 positivity and C1q binding capacity adequately reclassified patients at lower or higher risk for allograft loss at transplant (category-free net reclassification index, 1.30; 95% CI, 0.94 to 1.67; P<0.001 and 0.93; 95% CI, 0.49 to 1.36; P<0.001, respectively) and post-transplant (category-free net reclassification index, 1.33; 95% CI, 1.03 to 1.62; P<0.001 and 0.95; 95% CI, 0.62 to 1.28; P<0.001, respectively). Thus, pre- and post-transplant DSA monitoring and characterization may improve individual risk stratification for kidney allograft loss.
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Affiliation(s)
- Denis Viglietti
- Departments of Nephrology and Kidney Transplantation and
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France
- Departments of Kidney Transplantation and
| | - Dewi Vernerey
- Methodology Unit (EA 3181) CHRU de Besançon, France; and
| | | | | | - Olivier Aubert
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France
| | | | - Xavier Jouven
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France
| | - Christophe Legendre
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France
- Departments of Kidney Transplantation and
| | - Denis Glotz
- Departments of Nephrology and Kidney Transplantation and
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France
| | - Adriana Zeevi
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carmen Lefaucheur
- Departments of Nephrology and Kidney Transplantation and
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France
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20
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From Humoral Theory to Performant Risk Stratification in Kidney Transplantation. J Immunol Res 2017; 2017:5201098. [PMID: 28133619 PMCID: PMC5241462 DOI: 10.1155/2017/5201098] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/15/2016] [Indexed: 12/17/2022] Open
Abstract
The purpose of the present review is to describe how we improve the model for risk stratification of transplant outcomes in kidney transplantation by incorporating the novel insights of donor-specific anti-HLA antibody (DSA) characteristics. The detection of anti-HLA DSA is widely used for the assessment of pre- and posttransplant risks of rejection and allograft loss; however, not all anti-HLA DSA carry the same risk for transplant outcomes. These antibodies have been shown to cause a wide spectrum of effects on allografts, ranging from the absence of injury to indolent or full-blown acute antibody-mediated rejection. Consequently, the presence of circulating anti-HLA DSA does not provide a sufficient level of accuracy for the risk stratification of allograft outcomes. Enhancing the predictive performance of anti-HLA DSA is currently one of the most pressing unmet needs for facilitating individualized treatment choices that may improve outcomes. Recent advancements in the assessment of anti-HLA DSA properties, including their strength, complement-binding capacity, and IgG subclass composition, significantly improved the risk stratification model to predict allograft injury and failure. Although risk stratification based on anti-HLA DSA properties appears promising, further specific studies that address immunological risk stratification in large and unselected populations are required to define the benefits and cost-effectiveness of such comprehensive assessment prior to clinical implementation.
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21
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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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22
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Hönger G, Krähenbühl N, Dimeloe S, Stern M, Schaub S, Hess C. Inter-individual differences in HLA expression can impact the CDC crossmatch. ACTA ACUST UNITED AC 2016; 85:260-6. [PMID: 25786570 DOI: 10.1111/tan.12537] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/17/2014] [Accepted: 02/04/2015] [Indexed: 11/27/2022]
Abstract
How human leucocyte antigen (HLA) expression levels on human lymphocytes relate to clinically relevant in vitro cytotoxicity testing has not been defined. Here, cross-sectional (n = 14) and longitudinal (n = 6) semi-quantitative assessment of HLA expression on lymphocytes was performed. Complement-dependent cytotoxicity (CDC) and cellular allo-reactivity were assessed vis-à-vis target cells with defined levels of HLA expression. On CD4(+) and CD8(+) T-cells, and on B-cells, intra-individual HLA levels varied ≤1.5-fold, whereas inter-individual HLA expression varied 2.34-fold and 2.07-fold on CD4(+) and CD8(+) T-cells, respectively, and 2.90-fold on B-cells. Importantly, CDC crossmatch reactions induced by anti-HLA-A2 monoclonal antibody as well as patient sera solely containing HLA-A2 antibodies were significantly impacted by HLA-A2 expression levels on donor cells. Likewise, cytotoxicity of HLA-A2 reactive effector cells was induced proportionate to availability of HLA-A2. These data demonstrate that human HLA expression on lymphocytes from healthy blood donors is fairly stable intra-individually, yet varies significantly from person to person. Variability in HLA expression levels can impact functional cytotoxic reactions in vitro, including the widely used CDC crossmatch assay. Prospective studies are required to test the clinical relevance of this finding.
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Affiliation(s)
- G Hönger
- Immunobiology Laboratory, Department of Biomedicine, University of Basel, Basel, Switzerland; Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
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23
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Süsal C, Seidl C, Schönemann C, Heinemann FM, Kauke T, Gombos P, Kelsch R, Arns W, Bauerfeind U, Hallensleben M, Hauser IA, Einecke G, Blasczyk R. Determination of unacceptable HLA antigen mismatches in kidney transplant recipients: recommendations of the German Society for Immunogenetics. ACTA ACUST UNITED AC 2015; 86:317-23. [DOI: 10.1111/tan.12682] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Süsal
- Transplantation Immunology, Institute of Immunology; University of Heidelberg; Heidelberg Germany
| | - C. Seidl
- Institute for Transfusion Medicine and Immunohaematology; German Red Cross Baden-Württemberg-Hessen; Frankfurt am Main Germany
| | - C. Schönemann
- Center for Transfusion Medicine and Cell Therapy; Charité Campus Virchow Klinikum; Berlin Germany
| | - F. M. Heinemann
- Institute for Transfusion Medicine; University of Essen; Essen Germany
| | - T. Kauke
- Laboratory for Immunogenetics and General, Visceral, Transplantation, Vascular and Thoracic Surgery; Campus Grosshadern Ludwig-Maximilians-University; Munich Germany
| | - P. Gombos
- Transplantation Immunology, Institute of Immunology; University of Heidelberg; Heidelberg Germany
| | - R. Kelsch
- Institute of Transfusion Medicine and Transplantation Immunology; University Clinics of Münster; Münster Germany
| | - W. Arns
- Transplantation Programs; Clinics of City Cologne; Cologne Germany
| | - U. Bauerfeind
- Institute for Transfusion Medicine; Clinics of City Cologne; Cologne Germany
| | - M. Hallensleben
- Institute for Transfusion Medicine; Hannover Medical School; Hannover Germany
| | - I. A. Hauser
- Medical Clinic III; JW Goethe University; Frankfurt am Main Germany
| | - G. Einecke
- Internal Medicine Center, Clinic for Kidney and Hypertension Diseases; Hannover Medical School; Hannover Germany
| | - R. Blasczyk
- Institute for Transfusion Medicine; Hannover Medical School; Hannover Germany
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24
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Tambur AR, Herrera ND, Haarberg KMK, Cusick MF, Gordon RA, Leventhal JR, Friedewald JJ, Glotz D. Assessing Antibody Strength: Comparison of MFI, C1q, and Titer Information. Am J Transplant 2015; 15:2421-30. [PMID: 25930984 DOI: 10.1111/ajt.13295] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/09/2015] [Accepted: 02/28/2015] [Indexed: 02/06/2023]
Abstract
The presence of donor-specific HLA antibodies before or after transplantation may have different implications based on the antibody strength. Yet, current approaches do not provide information regarding the true antibody strength as defined by antigen-antibody dissociation rate. To assess currently available methods, we compared between neat mean fluorescence intensity (MFI) values, C1q MFI values, ethylenediaminetetraacetic acid (EDTA)-treated samples, as well as titration studies and peak MFI values of over 7000 Luminex-based single-antigen HLA antibody data points. Our results indicate that neat MFI values do not always accurately depict antibody strength. We further showed that EDTA treatment (6%) does not always remove all inhibitory factors compared with C1q or titration studies. In this study of patients presenting with multiple antibody specificities, a prozone effect was observed in 71% of the cohort (usually not affecting all antibody specificities within a single serum sample, though). Similar to titration studies, the C1q assay was able to address the issue of potential inhibition; however, its limitation is its low sensitivity and inability to detect the presence of weak antibodies. Titration studies are the only method among the approaches used in this study to provide information suggesting antigen-antibody dissociation rates and are, therefore, likely to provide better indication of true antibody strength.
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Affiliation(s)
- A R Tambur
- Transplant Immunology Laboratory, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - N D Herrera
- Transplant Immunology Laboratory, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - K M K Haarberg
- Transplant Immunology Laboratory, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - M F Cusick
- Transplant Immunology Laboratory, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - R A Gordon
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - J R Leventhal
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - J J Friedewald
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - D Glotz
- Nephrology and Transplantation Service, Hôpital Saint-Louis, Paris, France
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25
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Detecting the humoral alloimmune response: we need more than serum antibody screening. Transplantation 2015; 99:908-15. [PMID: 25839708 DOI: 10.1097/tp.0000000000000724] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Whereas many techniques exist to detect HLA antibodies in the sera of immunized individuals, assays to detect and quantify HLA-specific B cells are only just emerging. The need for such assays is becoming clear, as in some patients, HLA-specific memory B cells have been shown to be present in the absence of the accompanying serum HLA antibodies. Because HLA-specific B cells in the peripheral blood of immunized individuals are present at only a very low frequency, assays with high sensitivity are required. In this review, we discuss the currently available methods to detect and/or quantify HLA-specific B cells, as well as their promises and limitations. We also discuss scenarios in which quantification of HLA-specific B cells may be of additional value, besides classical serum HLA antibody detection.
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26
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Huber L, Lachmann N, Niemann M, Naik M, Liefeldt L, Glander P, Schmidt D, Halleck F, Waiser J, Brakemeier S, Neumayer HH, Schönemann C, Budde K. Pretransplant virtual PRA and long-term outcomes of kidney transplant recipients. Transpl Int 2015; 28:710-9. [DOI: 10.1111/tri.12533] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/22/2014] [Accepted: 01/26/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Lu Huber
- Section of Nephrology; Department of Medicine; Georgia Regents University Medical Centre; Augusta GA USA
| | - Nils Lachmann
- Center for Transfusion Medicine and Cell Therapy; Regional Tissue Typing Laboratory; Campus Virchow Klinikum; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Matthias Niemann
- Center for Transfusion Medicine and Cell Therapy; Regional Tissue Typing Laboratory; Campus Virchow Klinikum; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Marcel Naik
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Lutz Liefeldt
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Petra Glander
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Danilo Schmidt
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Fabian Halleck
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Johannes Waiser
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Susanne Brakemeier
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Hans H. Neumayer
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Constanze Schönemann
- Center for Transfusion Medicine and Cell Therapy; Regional Tissue Typing Laboratory; Campus Virchow Klinikum; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Klemens Budde
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
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27
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Bodnár Z, Sipka S, Tidrenczel E, Amador Marchante M. [Ten years' experience in the research of abdominal compartment syndrome (2004-2014)]. Orv Hetil 2015; 155:1820-30. [PMID: 25344852 DOI: 10.1556/oh.2014.30030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Intra-abdominal hypertension and abdominal compartment syndrome are frequent findings among severe surgical ill patients. In spite of the fast diagnostic methods and effective therapeutic procedures the mortality is high. The causing factors lead to increased intra-abdominal pressure and abdominal compartment syndrome. It can be defined as adverse physiologic consequences that occur as a result of an acute increase in the intra-abdominal pressure. The most common causes are retroperitoneal haemorrhage, pancreatitis, bowel obstruction, tense ascites, peritonitis and serious visceral edema due to massive fluid resuscitation. The affected systems are cardiovascular, respiratory, renal, central nervous systems, splanchnic organs, and finally the whole body. The diagnostic method is the intra-abdominal pressure monitoring. The bases of the treatment are adequate fluid resuscitation, non-surgical management and decompression. The authors review the topic including the international and Hungarian references based on their ten years experience.
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Affiliation(s)
- Zsolt Bodnár
- Torrevieja Egyetemi Oktatókórház (Hospital de Torrevieja) Általános Sebészeti Osztály (Servicio de Cirugía General) Carretera CV-95, s/n 03186 Torrevieja (Alicante) Spanyolország
| | - Sándor Sipka
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Belgyógyászati Intézet, Regionális Immunológiai Laboratórium Debrecen
| | - Edit Tidrenczel
- Torrevieja Egyetemi Oktatókórház (Hospital de Torrevieja) Sürgősségi Betegellátó Osztály Torrevieja (Alicante) Spanyolország
| | - Maria Amador Marchante
- Torrevieja Egyetemi Oktatókórház (Hospital de Torrevieja) Általános Sebészeti Osztály (Servicio de Cirugía General) Carretera CV-95, s/n 03186 Torrevieja (Alicante) Spanyolország
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28
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Grenzi PC, Campos ÉF, Silva HT, Felipe CR, Franco MF, Soares MF, Medina-Pestana JO, Gerbase-DeLima M. Post-transplant soluble CD30 levels are associated with early subclinical rejection in kidney transplantation. Transpl Immunol 2015; 32:61-5. [PMID: 25698648 DOI: 10.1016/j.trim.2015.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/25/2022]
Abstract
Several studies have shown association of high pre- or post-transplant levels of soluble CD30 (sCD30) with acute rejection and poor late kidney transplant outcome. Our goal was to investigate whether sCD30 levels at month-3 post-transplant are associated with subclinical rejection, presence of CD30(+) cells within the graft, and expression of immune response genes in peripheral blood mononuclear cells. The study comprised 118 adult first kidney graft recipients, transplanted at a single center, receiving tacrolimus in low concentration. All were submitted to a protocol biopsy at month-3. Subclinical rejection was identified in 10 biopsies and sCD30 levels ≥ 61.88 ng/mL (P = 0.004), younger recipient age (P = 0.030) and non-Caucasian ethnicity (P = 0.011) were independently associated with this outcome. Rare CD30(+) cells were present in only two biopsies. There was a correlation between sCD30 levels and CD30 gene expression in peripheral blood mononuclear cells (r = 0.385, P = 0.043). These results show that high sCD30 levels are independent predictors of graft dysfunction and may contribute to patient selection protocols by indicating those who could benefit from a more thorough evaluation.
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Affiliation(s)
- Patricia C Grenzi
- Instituto de Imunogenética-AFIP, Rua Loefgreen 1235, 04040-031 São Paulo, SP, Brazil; Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil.
| | - Érika F Campos
- Instituto de Imunogenética-AFIP, Rua Loefgreen 1235, 04040-031 São Paulo, SP, Brazil; Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil.
| | - Hélio T Silva
- Hospital do Rim e Hipertensão, Rua Borges Lagoa 960, 04038-002 São Paulo, SP, Brazil.
| | - Claudia R Felipe
- Hospital do Rim e Hipertensão, Rua Borges Lagoa 960, 04038-002 São Paulo, SP, Brazil.
| | - Marcelo F Franco
- Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil.
| | - Maria F Soares
- Universidade Federal do Paraná, Rua XV de Novembro 1299, 80060-000 Curitiba, PR, Brazil.
| | - José O Medina-Pestana
- Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil; Hospital do Rim e Hipertensão, Rua Borges Lagoa 960, 04038-002 São Paulo, SP, Brazil.
| | - Maria Gerbase-DeLima
- Instituto de Imunogenética-AFIP, Rua Loefgreen 1235, 04040-031 São Paulo, SP, Brazil; Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil.
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29
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Salvadori M, Bertoni E. What's new in clinical solid organ transplantation by 2013. World J Transplant 2014; 4:243-66. [PMID: 25540734 PMCID: PMC4274595 DOI: 10.5500/wjt.v4.i4.243] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/11/2014] [Accepted: 07/27/2014] [Indexed: 02/05/2023] Open
Abstract
Innovative and exciting advances in the clinical science in solid organ transplantation continuously realize as the results of studies, clinical trials, international conferences, consensus conferences, new technologies and discoveries. This review will address to the full spectrum of news in transplantation, that verified by 2013. The key areas covered are the transplantation activity, with particular regards to the donors, the news for solid organs such as kidney, pancreas, liver, heart and lung, the news in immunosuppressive therapies, the news in the field of tolerance and some of the main complications following transplantation as infections and cancers. The period of time covered by the study starts from the international meetings held in 2012, whose results were published in 2013, up to the 2013 meetings, conferences and consensus published in the first months of 2014. In particular for every organ, the trends in numbers and survival have been reviewed as well as the most relevant problems such as organ preservation, ischemia reperfusion injuries, and rejections with particular regards to the antibody mediated rejection that involves all solid organs. The new drugs and strategies applied in organ transplantation have been divided into new way of using old drugs or strategies and drugs new not yet on the market, but on phase Ito III of clinical studies and trials.
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30
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Israeli M, Pollack MS, Shaut CAE, Halpin A, DiPaola NR, Youngs D, Saidman SL. Concordance and discordance in anti-HLA antibody testing. Transpl Immunol 2014; 32:1-8. [PMID: 25460810 DOI: 10.1016/j.trim.2014.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/10/2014] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Correct identification of the specificity of antibodies directed against HLA using single antigen Luminex beads (SALB) is essential in current HLA laboratory practice for transplantation. The aim of this study was to investigate the magnitude of concordance and discordance among laboratories in testing for anti-HLA antibodies using SALB. METHOD 35 sera were distributed by the ASHI Proficiency Testing Program to HLA laboratories worldwide. We analyzed 4335 test results submitted between April 2010 and April 2013 by participating laboratories. RESULTS SALB was used by approximately 94% of the participating laboratories, yet concordant assignment of antibody specificity was imperfect. For each serum, the assignment of an average of 10 antibody specificities was discordant. Disagreement was observed for antibodies directed against common as well as uncommon antigens. The assignment of an average of 15 antibody specificities in each "positive" serum appeared to be influenced by vendor-dependent causes. Inter-vendor concordance was lower than intra-vendor concordance, indicating that vendor dependent factors may be a central cause for disagreement. CONCLUSIONS Our study illustrates the prevalence of concordance and discordance, also affected by unpremeditated causes, in reporting SALB antibody results. Insufficient concordance and standardization in antibody testing may have practical implications for organ allocation and organ sharing programs.
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Affiliation(s)
- Moshe Israeli
- Tissue Typing Laboratory, Rabin Medical Center, Beilinson Campus, Zabotinski Road, Petach-Tikva 49100, Israel; Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
| | - Marilyn S Pollack
- Department of Pathology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Carley A E Shaut
- School of Medicine, Oregon Health & Science University, 2611 SW 3rd Ave Suite 360, Portland, OR 97239, USA
| | - Anne Halpin
- Histocompatibility Laboratory, University of Alberta Hospital, 8220-112 St, Edmonton, AB T6G 2B7, Canada
| | - Nicholas R DiPaola
- Clinical Histocompatibility Lab, Wexner Medical Center, The Ohio State University, N943 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210, USA
| | - Danny Youngs
- Puget Sound Blood Center, 921 Terry Ave., Seattle, WA 98104, USA
| | - Susan L Saidman
- Histocompatibility Laboratory, Massachusetts General Hospital, 55 Fruit St, Room GRJ 220, Boston, MA 02114, USA
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31
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Pankewycz O, Soliman K, Laftavi MR. The increasing clinical importance of alloantibodies in kidney transplantation. Immunol Invest 2014; 43:775-89. [DOI: 10.3109/08820139.2014.910016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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32
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Heidt S, Eikmans M, Roelen DL, van Kooten C, Claas FH. Immunogenetics and immunology of transplantation in Leiden. Transpl Immunol 2014; 31:195-9. [DOI: 10.1016/j.trim.2014.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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33
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Nothing's perfect: The art of defining HLA-specific antibodies. Transpl Immunol 2014; 30:115-21. [DOI: 10.1016/j.trim.2014.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/12/2014] [Indexed: 11/19/2022]
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34
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Wettstein D, Opelz G, Süsal C. HLA antibody screening in kidney transplantation: current guidelines. Langenbecks Arch Surg 2013; 399:415-20. [PMID: 24271161 DOI: 10.1007/s00423-013-1138-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND In organ transplantation, the introduction of the solid phase immunoassay technology radically changed the practice of antibody monitoring against human leukocyte antigens (HLA). PURPOSE Precise identification of antibody specificities in complex sera of sensitized patients and monitoring of low levels of donor-specific HLA antibodies in the posttransplant phase became possible. However, at the same time, new technical problems and great variation emerged in the interpretation of test results, indicating a need for standardization. CONCLUSION In May 2012, The Transplantation Society (TTS) recruited a panel of laboratory and clinical experts to discuss emerging testing and clinical management issues that are associated with antibody testing in organ transplantation. In this article, we provide a summary of the TTS recommendations formulated in this international effort on the standardization of antibody monitoring in kidney transplantation.
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Affiliation(s)
- Dániel Wettstein
- Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
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35
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MHC universal cells survive in an allogeneic environment after incompatible transplantation. BIOMED RESEARCH INTERNATIONAL 2013; 2013:796046. [PMID: 24350288 PMCID: PMC3856147 DOI: 10.1155/2013/796046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/29/2013] [Accepted: 08/29/2013] [Indexed: 11/18/2022]
Abstract
Cell, tissue, and organ transplants are commonly performed for the treatment of different diseases. However, major histocompatibility complex (MHC) diversity often prevents complete donor-recipient matching, resulting in graft rejection. This study evaluates in a preclinical model the capacity of MHC class I-silenced cells to engraft and grow upon allogeneic transplantation. Short hairpin RNA targeting β2-microglobulin (RN_shβ2m) was delivered into fibroblasts derived from LEW/Ztm (RT1l) (RT1-Al) rats using a lentiviral-based vector. MHC class I (RT1-A-) expressing and -silenced cells were injected subcutaneously in LEW rats (RT1l) and MHC-congenic LEW.1W rats (RT1u), respectively. Cell engraftment and the status of the immune response were monitored for eight weeks after transplantation. In contrast to RT1-A-expressing cells, RT1-A-silenced fibroblasts became engrafted and were still detectable eight weeks after allogeneic transplantation. Plasma levels of proinflammatory cytokines IL-1α, IL-1β, IL-6, TNF-α, and IFN-γ were significantly higher in animals transplanted with RT1-A-expressing cells than in those receiving RT1-A-silenced cells. Furthermore, alloantigen-specific T-cell proliferation rates derived from rats receiving RT1-A-expressing cells were higher than those in rats transplanted with RT1-A-silenced cells. These data suggest that silencing MHC class I expression might overcome the histocompatibility barrier, potentially opening up new avenues in the field of cell transplantation and regenerative medicine.
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