1
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Rocha Y, Jaramillo A, Neumann J, Hacke K, Palou E, Torres J. Crossmatch assays in transplantation: Physical or virtual?: A review. Medicine (Baltimore) 2023; 102:e36527. [PMID: 38115324 PMCID: PMC10727546 DOI: 10.1097/md.0000000000036527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
The value of the crossmatch test in assessing pretransplant immunological risk is vital for clinical decisions, ranging from the indication of the transplant to the guidance of induction protocols and treatment with immunosuppressants. The crossmatch tests in transplantation can be physical or virtual, each with its advantages and limitations. Currently, the virtual crossmatch stands out for its sensitivity and specificity compared to the physical tests. Additionally, the virtual crossmatch can be performed in less time, allowing for a reduction in cold ischemia time. It shows a good correlation with the results of physical tests and does not negatively impact graft survival. Proper communication between clinicians and the transplant immunology laboratory will lead to a deeper understanding of each patient's immunological profile, better donor-recipient selection, and improved graft survival.
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Affiliation(s)
| | - Andrés Jaramillo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - Jorge Neumann
- Transplant Immunology Laboratory, Santa Casa Hospital, Porto Alegre, Brazil
| | - Katrin Hacke
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - Eduard Palou
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Juan Torres
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
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2
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Battle R, Pritchard D, Peacock S, Hastie C, Worthington J, Jordan S, McCaughlan JA, Barnardo M, Cope R, Collins C, Diaz-Burlinson N, Rosser C, Foster L, Kallon D, Shaw O, Briggs D, Turner D, Anand A, Akbarzad-Yousefi A, Sage D. BSHI and BTS UK guideline on the detection of alloantibodies in solid organ (and islet) transplantation. Int J Immunogenet 2023; 50 Suppl 2:3-63. [PMID: 37919251 DOI: 10.1111/iji.12641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023]
Abstract
Solid organ transplantation represents the best (and in many cases only) treatment option for patients with end-stage organ failure. The effectiveness and functioning life of these transplants has improved each decade due to surgical and clinical advances, and accurate histocompatibility assessment. Patient exposure to alloantigen from another individual is a common occurrence and takes place through pregnancies, blood transfusions or previous transplantation. Such exposure to alloantigen's can lead to the formation of circulating alloreactive antibodies which can be deleterious to solid organ transplant outcome. The purpose of these guidelines is to update to the previous BSHI/BTS guidelines 2016 on the relevance, assessment, and management of alloantibodies within solid organ transplantation.
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Affiliation(s)
- Richard Battle
- Scottish National Blood Transfusion Service, Edinburgh, UK
| | | | - Sarah Peacock
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Sue Jordan
- National Blood Service Tooting, London, UK
| | | | - Martin Barnardo
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rebecca Cope
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | | - Luke Foster
- Birmingham Blood Donor Centre, Birmingham, UK
| | | | - Olivia Shaw
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - David Turner
- Scottish National Blood Transfusion Service, Edinburgh, UK
| | - Arthi Anand
- Imperial College Healthcare NHS Trust, London, UK
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3
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Saadi G. Donor Selection and Outcome for Pediatric Living Donor Kidney Transplant. EXP CLIN TRANSPLANT 2022; 20:30-31. [DOI: 10.6002/ect.donorsymp.2022.l19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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4
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Hönger G, Niemann M, Schawalder L, Jones J, van Heck MR, van de Pasch LAL, Vendelbosch S, Rozemuller EH, Hösli I, Blümel S, Schaub S. Toward defining the immunogenicity of HLA epitopes: Impact of HLA class I eplets on antibody formation during pregnancy. HLA 2020; 96:589-600. [PMID: 32829523 DOI: 10.1111/tan.14054] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
Eplets are functional units of structural epitopes on donor HLA, potentially recognized by complementarity-determining regions of the paratope of the recipients' B-cell receptors or antibodies (Ab). Their individual immunogenicity is poorly described, yet this feature would be of clinical importance for pretransplant risk assessment. The aim of this study was to determine the relative immunogenicity of HLA class I eplets in the pregnancy setting, where mismatched eplets are present on paternal HLA antigens of the unborn child. One hundred fifty-nine predominantly Caucasian mothers giving birth at the University Hospital Basel and their first newborns were HLA-typed at high-resolution by next-generation sequencing (NGS) (NGSgo Workflow and NGSengine from GenDx; sequencing with a Miseq from Illumina) and eplets were determined using HLAMatchmaker. HLA class I specific IgG Ab was assessed in maternal sera drawn immediately after full-term delivery, by OneLambda LABScreen single antigen ibeads. The Ab profile was subsequently evaluated for eplet-associated patterns. All 72 currently Ab-verified HLA class I eplets were examined for their immunogenicity according to the frequency of child-specific HLA Ab (CSA) directed against their structures. Four hundred twelve of 477 (86.4%) paternal HLA-A, -B or -C alleles were mismatched. CSA were present in 46 mothers (28.9%), directed against 80 (19.4%) of these mismatches. The 10 most immunogenic eplets were 62GK, 145KHA, 144TKH, 62GE, 107W, 80I, 82LR, 41T, 127K, 45KE with immunogenicity rates between 45.8% and 27.3%. This pregnancy study also identified five non-reactive eplets: 62RR, 76ESN, 80TLR, 156DA, 163RW. Based on our results, immunogenic hot and cold spots on the surface of HLA class I molecules were localized and visualized on 3D models. This study strengthens the presumption that different eplets represent different immunogenic potentials. Validation of these results in the clinical transplant setting is an essential next step in identifying those eplets representing a particularly high-risk potential.
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Affiliation(s)
- Gideon Hönger
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland.,Transplantation Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland.,HLA-Diagnostics and Immunogenetics, Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Lara Schawalder
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - James Jones
- H&I Department, Royal Liverpool University Hospital, Liverpool, UK
| | | | | | | | | | - Irene Hösli
- Department of Obstetrics and Fetomaternal Medicine, University Hospital Basel, Basel, Switzerland
| | - Sarah Blümel
- Transplantation Immunology, Department of Biomedicine, University of 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-Diagnostics and Immunogenetics, Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
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5
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Tassone G, De Santis D, Vukovic I, Downing J, Martinez OP, D'Orsogna LJ. Different eplet software programs give discordant and incorrect results: An analysis of HLAMatchmaker vs Fusion Matchmaker Eplet calling software. HLA 2020; 96:52-63. [PMID: 32281731 DOI: 10.1111/tan.13897] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
Abstract
HLA eplet matching is a novel approach to define acceptable HLA mismatches for transplant recipients. We performed an eplet analysis of three different transplant case-series to determine if the available software programs gave accurate results. Eplet analysis was performed for three different transplant case-series typed by NGS for all HLA class I and II loci. The three different HLA datasets were entered into both the HLAMatchmaker program (v2.1) and OLI Fusion MatchMaker (v4.2) software tools. Eplet results which were discordant were cross referenced against eplet registry and published HLA allele sequence data to determine the correct assignments. The comparison reveals that there was poor concordance between the two eplet programs. Analysis of the same donor/recipient pair often gave rise to different total eplet scores, incorrect eplet mismatches and antibody verification status, and both programs have eplets assigned to incorrect HLA alleles. Overall, the OLI Fusion MatchMaker eplet tool gave more accurate and useful eplet results. Eplet matching is still primarily a research tool. Before eplet matching can enter routine clinical practice further work is required to validate the accuracy of available eplet software programs. Incorrect eplet assignment could have serious adverse consequences in the clinical transplant setting.
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Affiliation(s)
- Gabriella Tassone
- Department of Clinical Immunology and PathWest, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Dianne De Santis
- Department of Clinical Immunology and PathWest, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Irena Vukovic
- Department of Clinical Immunology and PathWest, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jonathan Downing
- Department of Clinical Immunology and PathWest, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Olga Patricia Martinez
- Department of Clinical Immunology and PathWest, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Lloyd J D'Orsogna
- Department of Clinical Immunology and PathWest, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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6
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De Santis D, Truong L, Martinez P, D'Orsogna L. Rapid high‐resolution
HLA
genotyping by
MinION
Oxford nanopore sequencing for deceased donor organ allocation. HLA 2020; 96:141-162. [DOI: 10.1111/tan.13901] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Dianne De Santis
- Department of Clinical ImmunologyPathWest, Fiona Stanley Hospital Perth Western Australia Australia
| | - Linh Truong
- Department of Clinical ImmunologyPathWest, Fiona Stanley Hospital Perth Western Australia Australia
| | - Patricia Martinez
- Department of Clinical ImmunologyPathWest, Fiona Stanley Hospital Perth Western Australia Australia
| | - Lloyd D'Orsogna
- Department of Clinical ImmunologyPathWest, Fiona Stanley Hospital Perth Western Australia Australia
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7
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Cargou M, Andreani M, Galluccio T, Guidicelli G, Visentin J. Characterization of the novel HLA-DRB3*02:142 allele by sequencing-based typing. HLA 2020; 95:581-582. [PMID: 32026620 DOI: 10.1111/tan.13819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/01/2020] [Indexed: 11/28/2022]
Abstract
HLA-DRB3*02:142 differs from HLA-DRB3*02:02:01:02 by one nucleotide substitution in codon 98 in exon 3.
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Affiliation(s)
- Marine Cargou
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, UMR CNRS 5164 Immunoconcept, Bordeaux, France
| | - Marco Andreani
- Laboratorio d'Immunogenetica dei Trapianti, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Tiziana Galluccio
- Laboratorio d'Immunogenetica dei Trapianti, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Gwendaline Guidicelli
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France
| | - Jonathan Visentin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, UMR CNRS 5164 Immunoconcept, Bordeaux, France
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8
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Menezes Teles e Oliveira D, Melo Santos de Serpa Brandão R, Claudio Demes da Mata Sousa L, das Chagas Alves Lima F, Jamil Hadad do Monte S, Sérgio Coelho Marroquim M, Vanildo de Sousa Lima A, Gilberto Borges Coelho A, Matheus Sousa Costa J, Martins Ramos R, Socorro da Silva A. pHLA3D: An online database of predicted three-dimensional structures of HLA molecules. Hum Immunol 2019; 80:834-841. [DOI: 10.1016/j.humimm.2019.06.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 12/01/2022]
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9
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Visentin J, Leu DL, Mulder A, Jambon F, Badier L, Lee JH, Guidicelli G, Bouthemy C, Ralazamahaleo M, Claas F, Di Primo C, Taupin JL. Measuring anti-HLA antibody active concentration and affinity by surface plasmon resonance: Comparison with the luminex single antigen flow beads and T-cell flow cytometry crossmatch results. Mol Immunol 2019; 108:34-44. [DOI: 10.1016/j.molimm.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/31/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022]
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10
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Cargou M, Andreani M, Battarra M, Guidicelli G, Visentin J. Characterization of the novel HLA-C*07:708 allele by sequencing-based typing. HLA 2019; 93:235-236. [PMID: 30729752 DOI: 10.1111/tan.13479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 11/30/2022]
Abstract
HLA-C*07:708 differs from HLA-C*07:01:01:01 by one nucleotide substitution at codon 258 in exon 4.
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Affiliation(s)
- Marine Cargou
- Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.,UMR CNRS 5164 Immunoconcept, Université de Bordeaux, Bordeaux, France
| | - Marco Andreani
- IRCCS Ospedale Pediatrico Bambino Gesù, Laboratorio d'Immunogenetica dei Trapianti, Roma, Italy
| | - Mariarosa Battarra
- IRCCS Ospedale Pediatrico Bambino Gesù, Laboratorio d'Immunogenetica dei Trapianti, Roma, Italy
| | - Gwendaline Guidicelli
- Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Jonathan Visentin
- Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.,UMR CNRS 5164 Immunoconcept, Université de Bordeaux, Bordeaux, France
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11
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Cargou M, Elsermans V, Top I, Guidicelli G, Visentin J. Characterization of the novel HLA-A*33:170 allele by sequencing-based typing. HLA 2019; 93:221-223. [PMID: 30729725 DOI: 10.1111/tan.13480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 11/29/2022]
Abstract
HLA-A*33:170 differs from HLA-A*33:01:01:01 by one nucleotide substitution at codon 222 in exon 4.
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Affiliation(s)
- Marine Cargou
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, UMR CNRS 5164 Immunoconcept, Bordeaux, France
| | | | - Isabelle Top
- CHRU de Lille, Institut d'Immunologie-HLA, Lille, France
| | - Gwendaline Guidicelli
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France
| | - Jonathan Visentin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, UMR CNRS 5164 Immunoconcept, Bordeaux, France
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12
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Cargou M, Elsermans V, Top I, Guidicelli G, Visentin J. Characterization of the novel
HLA‐DPB1*763:01
allele by sequencing‐based typing. HLA 2018; 92:429-431. [DOI: 10.1111/tan.13411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 10/28/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Marine Cargou
- CHU de Bordeaux Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin Bordeaux France
- Université de Bordeaux, UMR CNRS Bordeaux France
| | - Vincent Elsermans
- CHRU de Lille Institut d'Immunologie‐HLA, Bd du Professeur Jules Leclercq Lille France
| | - Isabelle Top
- CHRU de Lille Institut d'Immunologie‐HLA, Bd du Professeur Jules Leclercq Lille France
| | - Gwendaline Guidicelli
- CHU de Bordeaux Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin Bordeaux France
| | - Jonathan Visentin
- CHU de Bordeaux Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin Bordeaux France
- Université de Bordeaux, UMR CNRS Bordeaux France
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13
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Bouthemy C, Ralazamahaleo M, Jollet I, Filloux M, Visentin J, Guidicelli G. Improvement in HLA-typing by new sequence-specific oligonucleotides kits for HLA-A, -B, and -DRB1 loci. HLA 2018; 92:279-287. [PMID: 30129271 DOI: 10.1111/tan.13382] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/16/2018] [Indexed: 12/18/2022]
Abstract
Polymerase chain reaction sequence-specific oligonucleotide is commonly used for HLA-typing. We replaced our LabType SSO HD (HD) kits with LabType SSO XR (XR) kits (One Lambda, Inc., Canoga Park, California) for HLA-A, -B, and -DRB1 following acquisition of a LABScan3D analyzer. The XR kits have more bead regions than the HD kits, allowing for an extended number of probes and exon coverage. They are claimed to improve typing resolution and to diminish the number of allele ambiguities, including common and well-documented (CWD) and null alleles to be resolved. We retrospectively selected patients who had their first HLA-typing performed with the HD kits and their second determination with the XR kits between 2015 and 2016. Forty-two patients were selected for HLA-A typing comparison, and 48 for HLA-B and 41 for HLA-DRB1. XR kits significantly decreased the number of allele ambiguities for HLA-A and -B. On the other hand, the improvement was limited for the HLA-DRB1 locus. The XR kits did not resolve all the CWD HLA allele ambiguities, which may be important for organ and/or hematopoietic stem cell transplantations. The XR kits eliminated 88%, 62%, and 27% of null allele ambiguities for HLA-A, -B, and -DRB1 loci, respectively. In conclusion, the XR kits allow for a significant improvement of HLA-typing resolution for HLA-A and -B loci in comparison with HD kits. In contrast, the number of oligonucleotides in the XR HLA-DRB1 kit should be extended to include exon 3 at the very least. It could also be interesting to include oligonucleotides allowing HLA-DRB3, 4, and 5 typing.
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Affiliation(s)
- Charlène Bouthemy
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, Bordeaux, France
| | - Mamy Ralazamahaleo
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France
| | - Isabelle Jollet
- Etablissement Français du Sang Nouvelle Aquitaine, Laboratoire HLA, Poitiers, France
| | - Matthieu Filloux
- CHU de Limoges, Laboratoire d'Immunologie et Immunogénétique, Limoges, France.,Contrôle de la Réponse Immune B et Lymphoproliférations (CRIBL), UMR CNRS 7276-INSERM U 1262, Centre de Biologie et de Recherches en Santé, Limoges, France
| | - Jonathan Visentin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, Bordeaux, France.,Immuno ConcEpT, UMR CNRS 5164, Bordeaux, France
| | - Gwendaline Guidicelli
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France
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14
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Visentin J, Couzi L, Dromer C, Neau-Cransac M, Guidicelli G, Veniard V, Coniat KNL, Merville P, Di Primo C, Taupin JL. Overcoming non-specific binding to measure the active concentration and kinetics of serum anti-HLA antibodies by surface plasmon resonance. Biosens Bioelectron 2018; 117:191-200. [DOI: 10.1016/j.bios.2018.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 01/19/2023]
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15
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Terasaki Epitope Mismatch Burden Predicts the Development of De Novo DQ Donor-Specific Antibodies and are Associated With Adverse Allograft Outcomes. Transplantation 2018; 102:127-134. [PMID: 28731902 DOI: 10.1097/tp.0000000000001887] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND De novo DQ donor-specific antibody (DSA) are associated with antibody-mediated rejection and allograft loss. Given the lack of effective treatment of de novo DQ DSA, their prevention is vital if there is to be an improvement of long-term allograft survival. Using the HLA Matchmaker program, DQ epitope matching has been shown to be superior to HLA antigen mismatching in predicting de novo DQ DSA development. Whether DQ epitopes determined by Terasaki may more accurately predict de novo DQ development over HLA antigen matching is not known. METHODS We retrospectively analyzed the immunogenicity of the different HLA antigens, DQB1 alleles and DQB1 Teraskai epitopes (TerEp) in a large cohort of renal transplant recipients, by comparing patient mismatches with de novo DSA development. RESULTS Patients mismatched at a DQB1 allele were at significantly higher risk of developing de novo DSA compared with other mismatched HLA antigens. Patients mismatched at the DQ7 allele appear to be at specific risk. For patients mismatched at a single DQB1 allele, the risk of de novo DQ DSA development increases with the number of TerEp mismatches. However, the immunogenicity of the different DQ TerEps does not appear to be equal. Patients who develop antibodies against TerEps are at increased risk of adverse allograft outcomes, specifically antibody-mediated rejection. CONCLUSIONS Epitope mismatch burden, determined by TerEps, helps predict risk of de novo DQ DSA development and offers an alternative approach to predict an alloimmune response.
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16
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Guidicelli G, Elsermans V, Top I, Ralazamahaleo M, Visentin J. Characterization of the novel HLA-B*07:305 allele by sequencing-based typing. HLA 2018; 91:296-297. [DOI: 10.1111/tan.13224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 11/28/2022]
Affiliation(s)
- G. Guidicelli
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique; Hôpital Pellegrin; Bordeaux France
| | - V. Elsermans
- CHRU de Lille; Institut d'Immunologie-HLA; Lille France
| | - I. Top
- CHRU de Lille; Institut d'Immunologie-HLA; Lille France
| | - M. Ralazamahaleo
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique; Hôpital Pellegrin; Bordeaux France
| | - J. Visentin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique; Hôpital Pellegrin; Bordeaux France
- Université de Bordeaux; UMR CNRS 5164; Bordeaux France
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17
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Sypek MP, Hughes P, Kausman JY. HLA epitope matching in pediatric renal transplantation. Pediatr Nephrol 2017; 32:1861-1869. [PMID: 27995324 DOI: 10.1007/s00467-016-3557-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
Chronic graft loss due to antibody-mediated rejection (AMR) and the difficulty of re-transplanting highly sensitized patients are two of the major long-term challenges in pediatric renal transplantation. Treatments for AMR are often ineffective and desensitization protocols can be a high risk, making prevention a highly appealing strategy. Insights into the structural determinants of humoral alloantigenicity present an exciting opportunity to reassess our current paradigm of tissue matching and potentially preventing these complications. We review the theory behind human leukocyte antigen (HLA) B cell epitopes and the various systems that have been proposed to define them, including eplets. There is a growing body of clinical evidence suggesting that epitope-based tissue matching may be superior to traditional HLA antigen matching at predicting a range of clinical outcomes. However, additional studies are required to better understand the biological relevance of these systems of defining epitopes and their role in pediatric transplantation.
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Affiliation(s)
- Matthew P Sypek
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia. .,Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia. .,University of Melbourne, Melbourne, Australia.
| | - Peter Hughes
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia.,Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Joshua Y Kausman
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia.,Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
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18
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Abstract
This overview describes recent developments demonstrating the significance of epitopes in HLA antibody responses and matching for organ transplantation. HLA epitopes are defined by molecular modeling and amino acid comparisons between HLA alleles and the HLAMatchmaker algorithm considers eplets as essential components. Each allele represents a distinct string of eplets and matching is done by aligning donor and recipient strings. Evidence is summarized how mismatched eplet loads affect antibody responses and transplant outcomes. Epitope-based matching has been applied not only to identify acceptable mismatches for sensitized transplant candidates but also to identify more suitably mismatched donors for nonsensitized patients. Three recently proposed theories will further our understanding of the immunogenicity of individual HLA eplets.It has become apparent that epitope-based matching is superior to antigen matching; we should be ready soon to apply this principle in the clinical transplant setting very soon.
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Lobashevsky A, Goggins W, Rosner K, Taber T. Immunogenicity of Class I HLA but not preformed low MFI donor specific antibodies correlates with outcomes after first renal transplantation. Transpl Immunol 2017. [DOI: 10.1016/j.trim.2017.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Rapid and strong de novo donor-specific antibody development in a lung transplant recipient: Short communication/case report. Transpl Immunol 2016; 40:17-21. [PMID: 27979771 DOI: 10.1016/j.trim.2016.12.003] [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] [Received: 09/28/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 11/24/2022]
Abstract
A 66-yo female patient (typed B*39:01, 44:02) underwent first left single lung transplant (typed B*81:01, 15:17) on 02/07/2016 with negative for DSA in current and historical samples. On 02/17/2016 strong de novo DSA (MFI=15,200, C1q+) to B81 were detected. The recipient has two children typed B*07:02, 44:02 B*27:03, 39:01, and had received multiple vaccinations. Twinrix, Zostavax and MMR vaccines contain viruses grown on live human lung fibroblasts (MRC-5, typed B*07:02, 44:02, and WI-38, typed B*08:01, 58:01). Each dose of vaccine used for injection is known to contain protein components of fibroblasts including HLA. Most likely rapid de novo DSA development is due to booster effect produced by five exposures to mismatched B locus alleles which share the following epitopes: 70IAQ, 65QIA, 65QIA+76esn, 69aa+80n, and 163ew+73te. The later three consist of paired non-self and self eplets. Although likelihood of bystander effect produced by multiple vaccinations is low its impact cannot be ruled out.
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Duquesnoy RJ. Reflections on HLA Epitope-Based Matching for Transplantation. Front Immunol 2016; 7:469. [PMID: 27965660 PMCID: PMC5124729 DOI: 10.3389/fimmu.2016.00469] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/18/2016] [Indexed: 11/17/2022] Open
Abstract
HLA antibodies are primary causes of transplant rejection; they recognize epitopes that can be structurally defined by eplets. There are many reviews about HLA epitope-based matching in transplantation. This article describes some personal reflections about epitopes including a historical perspective of HLA typing at the antigen and allele levels, the repertoires of antibody-verified HLA epitopes, the use of HLAMatchmaker in determining the specificities of antibodies tested in different assays, and, finally, possible strategies to control HLA antibody responses.
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Duquesnoy RJ. The Antibody Response to HLA Mismatch: Putting Together the Pieces of a Puzzle. Am J Transplant 2015; 15:3019-20. [PMID: 26512940 DOI: 10.1111/ajt.13510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 01/25/2023]
Affiliation(s)
- R J Duquesnoy
- University of Pittsburgh Medical Center, Pittsburgh, PA
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Duquesnoy RJ, Marrari M, Mulder A. Usefulness of the Nonself-Self Algorithm of HLA Epitope Immunogenicity in the Specificity Analysis of Monospecific Antibodies Induced during Pregnancy. Front Immunol 2015; 6:180. [PMID: 26074914 PMCID: PMC4443772 DOI: 10.3389/fimmu.2015.00180] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/31/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND HLAMatchmaker is a program to analyze the epitope specificities of HLA antibodies. It considers each HLA allele as a string of eplets. Intralocus and interlocus comparisons between donor and recipient alleles offer a structural assessment of compatibility and an analysis of allele panel reactivity patterns can generate information about epitope specificities of HLA antibodies. However, HLAMatchmaker cannot always generate conclusive interpretations of reactivity patterns of all monospecific antibodies, which by definition recognize single epitopes. HYPOTHESIS We have therefore developed a new antibody analysis approach that utilizes the nonself-self algorithm of HLA epitope immunogenicity. It is based on the concept that HLA antibodies originate from B-cells with immunoglobulin receptors to self-HLA epitopes on one given allele and which can be activated by epitopes defined by a few nonself residue differences whereas the remainder of the structural epitope of the immunizing allele consists of self residues. METHODS Three human monoclonal class I antibodies from HLA typed women sensitized during pregnancy were tested in Ig-binding assays with single alleles on a Luminex platform. FINDINGS Three new HLA epitopes were identified; they are defined by combinations of nonself- and self-residues for one allele of the antibody producer. CONCLUSION The nonself-self paradigm of HLA epitope immunogenicity offers a second approach to analyze HLA antibody specificities.
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Affiliation(s)
| | - Marilyn Marrari
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arend Mulder
- Leiden University Medical Center, Leiden, Netherlands
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Abstract
Human leukocyte antigen (HLA) sensitisation occurs after transfusion of blood products and transplantation. It can also happen spontaneously through cross-sensitisation from infection and pro-inflammatory events. Patients who are highly sensitised face longer waiting times on organ allocation programmes, more graft rejection and therefore more side effects of immunosuppression, and poorer graft outcomes. In this review, we discuss these issues, along with the limitations of modern HLA detection methods, and potential ways of decreasing HLA antibody development. We do not discuss the removal of antibodies after they have developed.
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Affiliation(s)
- Lesley Rees
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK,
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Abstract
PURPOSE OF REVIEW Human leukocyte antigen (HLA) antibodies are now recognized as being specific for epitopes which can be defined structurally with amino acid differences between HLA alleles. This article addresses two general perspectives of HLA epitopes namely antigenicity, that is their reactivity with antibody and immunogenicity, that is their ability of eliciting an antibody response. RECENT FINDINGS Single-antigen bead assays have shown that HLA antibodies recognize epitopes that are equivalent to eplets or corresponding to eplets paired with other residue configurations. There is now a website-based Registry of Antibody-Defined HLA Epitopes (http://www.epregistry.com.br). Residue differences within eplet-defined structural epitopes may also explain technique-dependent variations in antibody reactivity determined in Ig-binding, C1q-binding and lymphocytotoxicity assays.HLA antibody responses correlate with the numbers of eplets on mismatched HLA antigens, and the recently proposed nonself-self paradigm of epitope immunogenicity may explain the production of epitope-specific antibodies. SUMMARY These findings support the usefulness of HLA matching at the epitope level, including the identification of acceptable mismatches for sensitized patients and permissible mismatching for nonsensitized patients aimed to reduce HLA antibody responses.
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Lights and shadows of anti-HLA antibodies detected by solid-phase assay. Immunol Lett 2014; 162:181-7. [DOI: 10.1016/j.imlet.2014.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 08/09/2014] [Accepted: 08/21/2014] [Indexed: 11/21/2022]
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Montgomery RA, Leffell MS, Zachary AA. Transplantation of the sensitized patient: histocompatibility testing. Methods Mol Biol 2013; 1034:117-125. [PMID: 23775734 DOI: 10.1007/978-1-62703-493-7_6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A component necessary for successful transplantation of the sensitized patient is timely and high quality support from the histocompatibility laboratory that helps guide selection of the best route to transplantation and the clinical care of the patient. Responsibilities of the laboratory include risk assessment, HLA typing, and accurate antibody characterization.
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Affiliation(s)
- Robert A Montgomery
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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