1
|
Kitpermkiat R, Kantachuvesiri S, Thotsiri S, Thammanichanond D, Rostaing L, Wiwattanathum P. Impact of donor-specific antibody with low mean fluorescence intensity on allograft outcomes in kidney transplant. Transpl Immunol 2024; 84:102054. [PMID: 38750972 DOI: 10.1016/j.trim.2024.102054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/08/2024] [Accepted: 05/11/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Immune-mediated rejection is the most common cause of allograft failure in kidney transplant (KT) patients. Exposure to alloantigen, including human leukocyte antigen (HLA), results in the production of donor-specific antibodies (DSA). There are limited data about low levels of mean fluorescence intensity (MFI) DSA, especially post-transplantation. This study evaluated allograft outcomes in KT patients with low MFI DSA. METHODS From January 2007 to December 2021, KT patients who were tested for post-transplant DSA at Ramathibodi Hospital, Bangkok, Thailand, with the DSA MFI ≤ 1000 were evaluated. These KT patients were categorized into two groups: very low DSA (VLL; MFI = 1-500) and low DSA (LL; MFI = 501-1000). All KT patients were evaluated for the primary outcomes, such as the incidence of acute rejection, serum creatinine levels at one and five years after transplantation as well as allograft and patient survivals. RESULTS Among 36 KT patients 25 were included as those with VLL and 11 as those with LL. The LL group had significantly higher T-cell mediated allograft rejection (TCMR) than the VLL group (45% vs. 12%, P = 0.04). In addition, 10 patients, 5 in the VLL group and 5 in the LL group developed antibody-mediated allograft rejection (ABMR). Both TCMR and ABMR were confirmed by biopsy results. There was a trend toward higher MFI in KT patients with ABMR than without ABMR (P = 0.22). At 5 post-transplant years, serum creatinine, allograft and patient survivals were comparable between these two groups. Furthermore, the univariate and multivariate analyzes revealed that the LL group was a high risk for rejection. CONCLUSION Low MFI DSA values after transplantation may be associated with a higher incidence of rejection, but this finding did not show differences in allograft and patient survival in this study's analysis.
Collapse
Affiliation(s)
- Rungthiwa Kitpermkiat
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Excellent Center for Organ Transplantation, 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; Excellent Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sansanee Thotsiri
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Excellent Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Duangtawan Thammanichanond
- Excellent Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lionel Rostaing
- Nephrology, Hemodialysis, Apheresis and Transplantation, CHU Grenoble-Alps, La Tronche, France
| | - Punlop Wiwattanathum
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Excellent Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
2
|
Yanyiam P, Kantachuvesiri S, Thammanichanond D. Impact of HLA Eplet Mismatch on De Novo Donor Specific Antibody Formation After Kidney Transplantation. Transplant Proc 2024; 56:515-520. [PMID: 38368130 DOI: 10.1016/j.transproceed.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND HLA eplet mismatching is an alternative approach to assess the risk of developing de novo donor-specific antibodies (dnDSA) in kidney transplantation. This strategy may offer more precise risk stratification than conventional approaches. This study aimed to find the association between HLA eplet mismatches and dnDSA formation in Thai kidney transplant recipients. METHODS A retrospective cohort study of kidney transplant recipients transplanted between 2000 and 2021 at Ramathibodi Hospital was performed. Recipients with pretransplant panel reactive antibody >0% or without DSA testing post-transplant were excluded. One hundred fifty recipients were included in the final study. High-resolution HLA typing was imputed by the HaploStat application. HLA eplet mismatch analysis was conducted using HLAMatchmaker. The association between the number of eplet mismatches and the risk of dnDSA formation was assessed by Cox regression analysis. RESULTS Of 150 recipients, 43 were dnDSA-positive, and 107 were dnDSA-negative patients. Compared with the dnDSA-negative group, patients with class II dnDSA had significantly more HLA-DR/DQ antibody (Ab)-verified eplet mismatches (6 [IQR 4-8] vs 4 [IQR 1-7], P = .045). The receiver operating characteristics analysis showed that the HLA-DQ Ab-verified eplet mismatches ≥2 were the best predictive of HLA class II dnDSA development. The number of HLA-DQ Ab-verified eplet mismatches ≥2 had the highest hazard rate of HLA class II dnDSA occurrence (adjusted HR, 3.74; 95%CI, 1.24-11.24, P = .019). CONCLUSIONS HLA-DQ Ab-verified eplet mismatches are significantly associated with class II dnDSA development. Our data supports the utility of HLA eplet mismatching for donor-recipient risk assessment.
Collapse
Affiliation(s)
- Peerawit Yanyiam
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, 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
| | - Duangtawan Thammanichanond
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
3
|
Kitpermkiat R, Thotsiri S, Arpornsujaritkun N, Sangkum P, Chantrathammachart P, Kitpoka P, Thammanichanond D, Virankabutra T, Kantachuvesiri S. A 46-Year-Old Thai Woman with Secondary Acquired Pure Red Cell Aplasia Due to Treatment with Recombinant Erythropoietin While on Dialysis for End-Stage Renal Disease Who Recovered Following ABO-Incompatible Kidney Transplantation. Am J Case Rep 2022; 23:e935451. [PMID: 35842751 PMCID: PMC9302208 DOI: 10.12659/ajcr.935451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Rungthiwa Kitpermkiat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sansanee Thotsiri
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nuttaporn Arpornsujaritkun
- Division of Vascular and Transplantation Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Premsant Sangkum
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichika Chantrathammachart
- Division of Hematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pimpun Kitpoka
- Department of Pathology, Faculty of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Duangtawan Thammanichanond
- Department of Pathology, Faculty of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanist Virankabutra
- Department of Anesthesiology, 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
| |
Collapse
|
4
|
Thammanichanond D, Tammakorn C, Ingsathit A, Worawichawong S, Sangkum P. Misidentification of preformed anti-HLA-DP antibodies leads to antibody-mediated kidney transplant rejection: a case report. BMC Nephrol 2022; 23:187. [PMID: 35581569 PMCID: PMC9115936 DOI: 10.1186/s12882-022-02807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Patients who are HLA-sensitized are at high risk for early antibody-mediated rejection (AMR) and worse outcomes. Therefore, it is crucial to detect the presence of donor-specific antibodies (DSAs) using pretransplant antibody identification and crossmatch assays. An error in antibody identification can lead to disastrous clinical outcomes. We present a case of acute AMR associated with preformed HLA-DPα and HLA-DPβ DSAs that were not identified before transplantation. Case presentation A 27-year-old woman received a second kidney transplant from a deceased donor. Her pretransplant panel-reactive antibody level was 94%. The complement-dependent cytotoxicity crossmatch was negative for T and B cells at the time of transplantation. She experienced early acute AMR proven by a kidney biopsy. Single antigen bead testing of the patient’s serum at the time of rejection as well as the pre-second transplant serum revealed strong antibodies against the DPA1*01:03 and DPB1*02:01 alleles in the second donor. These antibodies were not identified by phenotypic bead assay during the patient’s time on the waiting list. The patient was treated with plasmapheresis and anti-thymocyte globulin. However, she experienced abdominal pain on day 37 post-transplantation. Surgical exploration revealed a laceration on the transplanted kidney, which was then repaired. Subsequently, infected hematoma was suspected and the transplanted kidney was removed. Conclusion The present case highlights the clinical significance of preformed HLA-DPα and HLA-DPβ DSAs. Accuracy in determination of HLA antibodies before transplantattion is critical for transplant outcome. HLA-DP typing and single antigen bead testing are recommended for a precise antibody interpretation, especially in highly sensitized patients. Careful interpretation of antibody testing results is essential for the success of organ transplantation.
Collapse
Affiliation(s)
- Duangtawan Thammanichanond
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok, 10400, Thailand.
| | - Chutima Tammakorn
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok, 10400, Thailand
| | - Atiporn Ingsathit
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchin Worawichawong
- Immunopathology Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Premsant Sangkum
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
5
|
Pipatpongsopon P, Naratreekoon B, Incharoen P, Thammanichanond D, Yingchoncharoen T, Kanthatat N, Chandavimol M, Samankatiwat P. RESCUE THERAPY OF LATE ANTIBODY-MEDIATED REJECTION WITH SEVERE GRAFT DYSFUNCTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03751-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
6
|
Kantachuvesiri S, Ingsathit A, Thammanichanond D, Choochaeam K, Sra-Ium S, Kitiyakara C, Nongnuch A, Sakulchairungrueng B, Worawichawong S. Double-Filtration Plasmapheresis Plus Low-Dose Anti-thymocyte Globulin and Tacrolimus in Asian Living-Donor Kidney Transplantation With Donor-Specific Anti-HLA Antibody. Transplant Proc 2020; 53:995-1000. [PMID: 32948312 DOI: 10.1016/j.transproceed.2020.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/08/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pretransplant desensitization protocols, including plasmapheresis, intravenous immunoglobulin, induction antibody therapy, and intensive maintenance immunosuppression, are generally employed in kidney transplant recipients who have positive status for donor-specific anti-HLA antibody (DSA). To avoid serious infectious complications, the authors designed a novel low-dose protocol in Thai patients undergoing DSA+ living-related kidney transplantation (LRKT). METHODS A retrospective cohort study of the patients who underwent DSA+ LRKT was conducted. The novel protocol consisted of 3 to 5 sessions of pretransplant double-filtration plasmapheresis (DFPP) with or without low-dose intravenous immunoglobulin together with low-dose anti-thymocyte globulin (ATG) induction (1-1.5 mg/kg/d for 3-4 days) and low-dose tacrolimus (Tac) (trough level 5-10 ng/mL), mycophenolate, and prednisolone. RESULTS The study included 17 patients. The lymphocyte crossmatch via complement-dependent cytotoxicity was negative in 12 patients and positive for B cell immunoglobulin M in 5 patients. The novel desensitization protocol resulted in a decrease of at least 50% of DSA mean fluorescence intensity from baseline (from 4320 ± 549 before DFPP to 1601 ± 350 before transplantation, P < .005) and successful kidney transplantation with good allograft function in all cases. Early DSA rebound was observed in 3 patients after transplantation, and kidney biopsy revealed subclinical antibody-mediated rejection in 1 patient and diffuse C4d staining without cell infiltration in 2 patients. There were good long-term outcomes in patient and graft survival (100% and 94.1%, respectively). Only 1 allograft loss occurred because of nonadherence. The majority of patients have stable allograft function with serum creatinine less than 1.5 mg/dL. However, infections, including CMV and other organisms, were commonly observed. CONCLUSIONS Desensitization protocol with DFPP, low-dose ATG, and Tac provides excellent outcomes in living donor kidney transplantation in highly sensitized Asian populations.
Collapse
Affiliation(s)
- Surasak Kantachuvesiri
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok Thailand.
| | - Atiporn Ingsathit
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok Thailand; Section for Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Phyathai, Bangkok, Thailand
| | - Duangtawan Thammanichanond
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Ramathibodi Hospital, Phyathai, Bangkok, Thailand
| | - Kunvadee Choochaeam
- Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Supasil Sra-Ium
- Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chagriya Kitiyakara
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok Thailand
| | - Arkom Nongnuch
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok Thailand
| | - Bundit Sakulchairungrueng
- Vascular and Transplantation Unit, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchin Worawichawong
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Ramathibodi Hospital, Phyathai, Bangkok, Thailand
| |
Collapse
|
7
|
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: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
8
|
Thammanichanond D, Tammakorn C, Worawichawong S, Kantachuvesiri S. Antibody-Mediated Rejection Due to Donor-Specific HLA-DQB1 and DQA1 Antibodies After Kidney Transplantation: A Case Report. Transplant Proc 2020; 52:1931-1936. [PMID: 32444122 DOI: 10.1016/j.transproceed.2020.02.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/17/2020] [Accepted: 02/22/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Donor-specific HLA antibody (DSA) is associated with the risk of allograft loss due to antibody-mediated rejection (ABMR). The majority of de novo DSA after kidney transplantation is directed toward donor HLA-DQ antigens. A HLA-DQ antigen is a heterodimer consisting of an alpha and beta chain. Traditionally, HLA-DQA1 typing has not been part of the pretransplant evaluation. Therefore, DQ alpha proteins are not usually taken into account in the interpretation of HLA-DQ antibody reactions. METHODS We hereby present a case of a kidney transplant recipient with 0% pretransplant panel reactive antibody. She received kidney allograft from her husband. Two years after transplantation, she experienced abdominal swelling, and enlargement of transplanted kidney was identified. A biopsy of the allograft kidney demonstrated chronic active ABMR. DSAs were investigated using immunoglobulin G (IgG) and C1q single antigen bead (SAB) assay. HLAMatchmaker analysis was performed to identify eplets that explain the antibody reactivity patterns. RESULTS The IgG SAB analysis of a patient's serum at the time of rejection showed positive reactions with all DQ2-carrying beads with mean fluorescence intensity (MFI) > 10000. However, the C1q assay demonstrated strong reaction to only HLA-DQA1∗05:01-DQB1∗02:01-carrying bead with MFI = 22462, whereas weak or no reactions against other HLA-DQ2-carrying beads were found. High-resolution HLA typing revealed that HLA-DQA1∗05:01 and DQB1∗02:01 were mismatched donor antigens. HLAMatchmaker analysis showed that the antibodies were reactive toward 40GR3 eplet on DQA1 and 45GE3 eplet on DQB1. CONCLUSIONS This case highlights the clinical significance of antibodies specific to both DQ alpha and DQ beta chains after kidney transplantation.
Collapse
Affiliation(s)
- Duangtawan Thammanichanond
- 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
| | - Suchin Worawichawong
- Immunopathology Laboratory, Department of Pathology, 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
| |
Collapse
|
9
|
Thammanichanond D, Parapiboon W, Mongkolsuk T, Worawichawong S, Tammakorn C, Kitpoka P. Acute Antibody-Mediated Rejection by De Novo Anti-HLA-DPβ and -DPα Antibodies After Kidney Transplantation: A Case Report. Transplant Proc 2018; 50:2548-2552. [DOI: 10.1016/j.transproceed.2018.02.190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/19/2018] [Indexed: 12/30/2022]
|
10
|
Arnold ML, Bach C, Heinemann FM, Horn PA, Ziemann M, Lachmann N, Mühlbacher A, Dick A, Ender A, Thammanichanond D, Schaub S, Hönger G, Fischer GF, Mytilineos J, Hallensleben M, Hitzler WE, Seidl C, Spriewald BM. Anti-HLA alloantibodies of the IgA isotype in re-transplant candidates part II: Correlation with graft survival. Int J Immunogenet 2018; 45:95-101. [PMID: 29575597 DOI: 10.1111/iji.12363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/29/2018] [Accepted: 03/01/2018] [Indexed: 11/30/2022]
Abstract
We reported previously on the widespread occurrence of anti-HLA alloantibodies of the IgA isotype (anti-HLA IgA) in the sera of solid-organ re-transplantation (re-tx) candidates (Arnold et al., ). Specifically focussing on kidney re-tx patients, we now extended our earlier findings by examining the impact of the presence and donor specificity of anti-HLA IgA on graft survival. We observed frequent concurrence of anti-HLA IgA and anti-HLA IgG in 27% of our multicenter collective of 694 kidney re-tx patients. This subgroup displayed significantly reduced graft survival as evidenced by the median time to first dialysis after transplantation (TTD 77 months) compared to patients carrying either anti-HLA IgG or IgA (TTD 102 and 94 months, respectively). In addition, donor specificity of anti-HLA IgA had a significant negative impact on graft survival (TTD 74 months) in our study. Taken together, our data strongly indicate that presence of anti-HLA IgA, in particular in conjunction with anti-HLA-IgG, in sera of kidney re-tx patients is associated with negative transplantation outcome.
Collapse
Affiliation(s)
- M-L Arnold
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - C Bach
- Department of Internal Medicine 5 - Hematology and Oncology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - F M Heinemann
- Institute for Transfusion Medicine, University Hospital Essen, Essen, Germany
| | - P A Horn
- Institute for Transfusion Medicine, University Hospital Essen, Essen, Germany
| | - M Ziemann
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck- Kiel, Germany
| | - N Lachmann
- HLA Laboratory, Center for Tumor Medicine, Charité, Berlin, Germany
| | - A Mühlbacher
- Central Institute for Blood Transfusion and Immunology, General Hospital and University Clinics, Innsbruck, Austria
| | - A Dick
- Laboratory for Immunogenetics, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - A Ender
- Central Institute for Transfusion Medicine and Blood Donation, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - D Thammanichanond
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Mahidol University Bangkok, Bangkok, Thailand
| | - S Schaub
- HLA-Diagnostics and Immunogenetics, Department of Laboratory Medicine, Transplantation Immunology & Nephrology, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - G Hönger
- Transplantation Immunology and Nephrology, Department of Biomedicine, University Basel, Basel, Switzerland
| | - G F Fischer
- Department for Blood Group Serology and Transfusion Medicine, Medical University Vienna, Vienna, Austria
| | - J Mytilineos
- Institute of Clinical Transfusion Medicine and Immunogenetics, University Hospital of Ulm, Ulm, Germany
| | - M Hallensleben
- Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | - W E Hitzler
- Transfusion Center, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - C Seidl
- German Red Cross Blood Donor Service, Institute for Transfusion Medicine and Immunohaematology, Frankfurt, Germany
| | - B M Spriewald
- Department of Internal Medicine 5 - Hematology and Oncology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| |
Collapse
|
11
|
Tipjaiaue P, Ingsathit A, Kantachuvesiri P, Rattanasiri S, Thammanichanond D, Mongkolsuk T, Arpornsujaritkun N, Sumethkul V, Kantachuvesiri S. Outcome of Pretransplantation Therapeutic Plasma Exchange in Highly Sensitized Deceased-donor Kidney Transplant Recipients. Transplant Proc 2017; 49:1249-1255. [PMID: 28735989 DOI: 10.1016/j.transproceed.2017.02.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/21/2017] [Accepted: 02/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sensitization is associated with a high rate of post-transplantation rejection. A desensitization protocol using therapeutic plasma exchange (TPE) was proposed to reduce anti-HLA antibody before transplantation, but there has been limited data regarding the efficacy of pretransplantation TPE in highly sensitized deceased-donor kidney transplantation (DDKT). METHODS A retrospective cohort study of 142 patients who received DDKT was conducted and divided into two groups: a high-panel-reactive antibody (PRA) >50% group and a low-PRA ≤50% group. The high-PRA group was sub-divided into those who received and did not receive pretransplantation TPE. Donor-specific anti-HLA antibodies (DSA) were also collected pretransplantation in the high-PRA group. RESULTS The probability of acute rejection was 26, 4, and 9 cases/1000/person month in the high-PRA group with no TPE, the high-PRA group receiving TPE, and the low-PRA group, respectively (P = .0208). In the multivariable logistic regression analysis, the hazard ratio for graft rejection was 2.37 (95% confidence interval: 0.89 to 6.35) and 2.22 (95% confidence interval: 0.54 to 9.13) in the group of high-PRA who received TPE and high-PRA with no TPE, compared with the low-PRA group, respectively (P value not significant). The incidence of antibody-mediated rejection in 6 months in the DSA-positive subgroup was not different between those who received TPE or no TPE. CONCLUSION Desensitization with TPE is a reasonable alternative for highly sensitized DDKT. Patients who received pretransplantation TPE had a lower incidence of acute rejection compared to the group that did not receive TPE. However, pretransplantation TPE alone was not effective in the prevention of acute rejection in recipients with DSA.
Collapse
Affiliation(s)
- P Tipjaiaue
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok, Thailand
| | - A Ingsathit
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok, Thailand; Section for Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Phyathai, Bangkok, Thailand
| | - P Kantachuvesiri
- Department of Medicine, Nottingham City Hospital, Nottingham, United Kingdom
| | - S Rattanasiri
- Section for Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Phyathai, Bangkok, Thailand
| | - D Thammanichanond
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Ramathibodi Hospital, Phyathai, Bangkok, Thailand
| | - T Mongkolsuk
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Ramathibodi Hospital, Phyathai, Bangkok, Thailand
| | - N Arpornsujaritkun
- Vascular and Transplantation unit, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - V Sumethkul
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok, Thailand
| | - S Kantachuvesiri
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok, Thailand.
| |
Collapse
|
12
|
Thammanichanond D, Wiwattanathum P, Mongkolsuk T, Kantachuvesiri S, Worawichawong S, Vallipakorn SA, Kitpoka P. Role of Pretransplant Complement-fixing Donor-specific Antibodies Identified by C1q Assay in Kidney Transplantation. Transplant Proc 2017; 48:756-60. [PMID: 27234729 DOI: 10.1016/j.transproceed.2015.12.116] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/30/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Kidney transplant recipients who have pretransplant donor-specific human leukocyte antigen (HLA) antibodies have greater risk for developing allograft rejection and allograft loss. However, there is a varied effect of graft injury among patients with pretransplantation donor-specific antibodies (DSA). The difference of complement activating ability may be the reason why some DSA are detrimental to kidney allograft. This study aimed to investigate the association between pretransplantation C1q-binding DSA and clinical outcomes. METHODS This retrospective study included 48 pretransplant sera from kidney transplant recipients who had pretransplant DSA with negative complement-dependent cytotoxic (CDC) crossmatches. The IgG DSA testing and C1q testing were performed on a Luminex platform with single antigen bead assay. The clinical outcomes between C1q-positive and C1q-negative groups were compared. RESULTS C1q-positive DSA were detected in 12 out of 48 patients (25%). The incidences of antibody-mediated rejection (AMR) were higher among patients with C1q-positive DSA than patients with C1q-negative DSA (66.7% vs 41.7%). Nevertheless, there were no statistically significant associations between C1q-DSA and AMR (odds ratio 2.8, 95% CI 0.68-11.6, P = .13) and between C1q-DSA and graft loss (odds ratio 0.52, 95% CI 0.09-2.89, P = .44). The C1q-positive DSA group had significantly higher IgG DSA MFI than the C1q-negative DSA group (P < .001). CONCLUSION C1q-binding ability of DSA in pretransplant sera of kidney recipients was not associated with antibody-mediated rejection and graft loss post-transplantation. In contrast with the clinical relevance of C1q testing in the post-transplantation setting, C1q testing in pretransplant sera has limited use for immunological risk assessment.
Collapse
Affiliation(s)
- D Thammanichanond
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - P Wiwattanathum
- Nephrology Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - T Mongkolsuk
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Kantachuvesiri
- Nephrology Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Worawichawong
- Immunopathology Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S A Vallipakorn
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - P Kitpoka
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
13
|
Mongkolsuk T, Tammakorn C, Kitpoka P, Thammanichanond D. A Rare HLA-DRB1*14:22-DQB1*04:01 Haplotype in a Kidney Donor: Implication in the Interpretation of Donor-Specific Antibody in Kidney Transplantation-A Case Report. Transplant Proc 2016; 48:943-5. [PMID: 27234774 DOI: 10.1016/j.transproceed.2015.12.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/07/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The presence of donor-specific human leukocyte antigen antibodies (HLA-DSA) can be determined by performing Luminex assay with single-antigen beads. The single-antigen beads' panels cover the most frequent HLA alleles of the HLA-A, B, C, DRB1, DRB3/4/5, DQB, and DP loci, although the HLA typing for deceased donors often includes only HLA-A, B, and DR. Therefore, the information of haplotypic association between DRB1 and DQB1 is essential for the analysis of HLA-DSA, especially when HLA-DQ antibodies are identified in the patient's serum. CASE REPORT We report the finding of a rare HLA-DRB1*14:22-DQB1*04:01 haplotype in a Thai potential kidney donor. HLA class I and class II high-resolution typing were performed by a method of polymerase chain reaction with the use of sequence-specific primers. The HLA-A*24:02-C*04:06-B*13:01-DRB3*02:02-DRB1*14:22-DQA1*05:05-DQB1*04:01 haplotype in the kidney donor was confirmed by segregation analysis in the kidney donor's family. This rare haplotype was also identified in her father and the 2 of her offspring. CONCLUSIONS To our knowledge, this is the 1st report of the rare HLA-DRB1*14:22-DQB1*04:01 haplotype in Thai individuals. The information of the rare HLA-DR-DQ haplotypic association provides a caution for HLA laboratory personnel when analyzing HLA-DSA in a patient with HLA-DQ antibodies and the HLA-DQ typing of a deceased donor is unavailable.
Collapse
Affiliation(s)
- T Mongkolsuk
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - C Tammakorn
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - P Kitpoka
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - D Thammanichanond
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
14
|
Kitpoka P, Tammakorn C, Chaisri S, Leelayuwat C, Mongkolsuk T, Thammanichanond D. Genetic profiles of killer-cell immunoglobulin-like receptors and HLA ligands in Thai blood donors. Hum Immunol 2016; 77:470-5. [PMID: 27131859 DOI: 10.1016/j.humimm.2016.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 04/13/2016] [Accepted: 04/25/2016] [Indexed: 01/10/2023]
Abstract
Killer-cell immunoglobulin-like receptors (KIRs) play an important role in natural killer (NK) cell regulation. Interaction of KIRs with human leukocyte antigen (HLA) class I molecules can transmit signals to regulate the function of NK cells. In this study, the diversities of KIR genes and their ligands in 500 Thai blood donors were investigated. The coexistence of inhibitory KIRs (iKIR), activating KIRs (aKIR) and their ligands in the same individuals were also analyzed. Overall, 36 KIR genotypes were identified. The most common genotype was genotype AA1 (40.8%). All individuals carried at least one iKIR-HLA pair whereas 18% of the individuals lacked aKIR-HLA pair. The most common compound KIR-HLA profile was the presence of 3 iKIR-HLA pairs with 1 aKIR-HLA pair (21.4%). The most common compound gene profile of KIR-HLA pairs was the combined presence of KIR2DL3-C1, 3DL1-Bw4, 3DL2-A3/A11 and the full length KIR2DS4-its ligands (8%). This study provided a comprehensive analysis of the KIR-HLA profiles in Thai blood donors in regards to KIR genotypes, HLA ligands, KIR-HLA ligand pairs and compound gene profiles of both iKIRs and aKIRs and their ligands. These findings will be useful as baseline information for further studies in the associations of KIR genes and various diseases.
Collapse
Affiliation(s)
- Pimpun Kitpoka
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Chutima Tammakorn
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Suwit Chaisri
- The Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand; Chulabhorn International College of Medicine (CICM), Thammasat University Rangsit campus, Pathum Thani 12120, Thailand
| | - Chanvit Leelayuwat
- The Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand; Department of Clinical Immunology and Transfusion Sciences, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Tasanee Mongkolsuk
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Duangtawan Thammanichanond
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
| |
Collapse
|
15
|
Wiwattanathum P, Ingsathit A, Thammanichanond D, Mongkolsuk T, Sumethkul V. Significance of HLA Antibody Detected by PRA-Bead Method in Kidney Transplant Outcomes. Transplant Proc 2016; 48:761-5. [PMID: 27234730 DOI: 10.1016/j.transproceed.2016.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/06/2016] [Accepted: 02/15/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The impact of specific HLA antibodies on the allograft function in the Luminex era is not clearly known. This study aimed to investigate kidney transplantation outcomes in patients with different anti-HLA antibody status as detected by Luminex PRA. METHODS This retrospective study included 106 deceased-donor kidney transplantation (DDKT) patients divided into 3 groups by PRA status as detected by PRA-bead: (1) PRA = 0; (2) positive PRA but with negative antibody against donor's HLA antigens; and (3) positive PRA with positive anti-HLA antibody specificity against donor's HLA antigens. RESULTS There were 65, 23, and 18 patients in groups 1, 2, and 3, respectively. Early allograft rejections were highest in group 3 (22.2%) (P = .02). In multivariate analysis, delayed graft function was the only factor that was associated with allograft rejection (hazard ratio, 8.9; 95% confidence interval, 1.9-39.8; P = .004). Estimated glomerular filtration rates at 1 year of the 3 groups were 54.6, 55.8, and 60.0 mL/min (P = .71). One-year allograft failure and death were not different among the 3 groups. Expanded-criteria deceased donors were associated with both allograft failure (P = .003) and patient death (P = .02). CONCLUSIONS Anti-HLA antibody as detected by Luminex PRA was associated with early allograft rejection but not graft or patient survival. The effect of newer treatment modalities can improve the outcomes of PRA-positive patients to be similar to nonsensitized patients at 1 year.
Collapse
Affiliation(s)
- P Wiwattanathum
- Division of Nephrology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - A Ingsathit
- Division of Nephrology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - D Thammanichanond
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - T Mongkolsuk
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - V Sumethkul
- Division of Nephrology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
16
|
Krongvorakul J, Kantachuvesiri S, Ingsathit A, Rattanasiri S, Mongkolsuk T, Kitpoka P, Thammanichanond D. Association of soluble human leukocyte antigen-G with acute tubular necrosis in kidney transplant recipients. Asian Pac J Allergy Immunol 2015; 33:117-22. [PMID: 26141032 DOI: 10.12932/ap0528.33.2.2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/13/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Human leukocyte antigen (HLA)-G is a nonclassical HLA class I molecule that displays strong immune-inhibitory properties and has been associated with allograft acceptance. However, there are conflicting data on the correlation of soluble HLA-G (sHLA-G) and acute rejection and no data on the correlation with acute tubular necrosis in kidney transplantation. OBJECTIVE To evaluate the association of sHLA-G level in early post-transplant period and allograft rejection/ and acute tubular necrosis (ATN) in kidney transplant recipients. METHODS The sera procured before transplantation and serially on day 3 and day 7 after transplantation from 76 kidney transplant recipients were analyzed for the level of sHLA-G by enzyme-linked immunosorbent assay. RESULTS The levels of sHLA-G from three serial sera did not differ between patients with acute rejection and patients without rejection. However, the sHLA-G levels on day 3 post-transplant and day 7 post-transplant in patients with ATN were significantly higher than that in patients without ATN (16.3 vs 9.85 U/ml, p = 0.018, for day 3 post-transplant and 12.47 vs 5.42 U/ml, p = 0.044, for day 7 post-transplant). In addition, the ROC analysis of sHLA-G for identifying patients with ATN showed that the area under curve was 0.67 (95% confidence interval 0.54-0.80). CONCLUSIONS There was no significant difference for sHLA-G levels between patients with acute rejection and without rejection. Interestingly, high levels of sHLA-G in day 3 and day 7 after transplantation were associated with acute tubular necrosis. Our findings raise the question whether the increased levels of sHLA-G in patients with acute tubular necrosis after transplantation might be a result of ischemia and reperfusion injury.
Collapse
Affiliation(s)
- Jatupon Krongvorakul
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | | | | |
Collapse
|
17
|
Mongkolsuk T, Ingsathit A, Worawichawong S, Jirasiritham S, Kitpoka P, Thammanichanond D. Shared molecular eplet stimulates acute antibody-mediated rejection in a kidney transplant recipient with low-level donor-specific antibodies: a case report. Transplant Proc 2014; 46:644-7. [PMID: 24656035 DOI: 10.1016/j.transproceed.2013.10.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/02/2013] [Indexed: 12/24/2022]
Abstract
HLA antibodies usually recognize epitopes rather than antigens. This case report reveals that acute antibody-mediated rejection (AMR) that occurred in a kidney transplant recipient with low-level donor-specific antibodies (DSAs) could be explained by shared epitope. A 39-year-old woman received a first kidney transplant from a deceased donor (HLA-DRB1 11:06, 12:02, DRB3 02:02, 03:01). She developed acute AMR confirmed by kidney biopsy on day 4 after transplantation. Antibody testing with pretransplant serum showed anti-DR11 DSA below cutoff level (mean fluorescence intensity [MFI], 702; cutoff >1,000). However, high-level DSAs were detected on day 5 after transplantation (anti-DR11 MFI, 8,531; anti-DR12 MFI, 3,146). We hypothesized that the sharp rise in DSA levels was a result of anamnestic response with donor-antigen sensitization that occurred during pregnancy. High-resolution HLA-DR typing of her husband showed HLA-DRB1 03:01, 15:02:01, DRB3 02:02, DRB5 01:02. No sharing between donor HLAs eliciting reactive antibodies and her husband's HLAs was detected. Nevertheless, we speculated that shared epitope, not antigen, was the cause of allosensitization. To identify the shared epitope recognized by patient's antibodies, we used HLAmatchmaker, a computer algorithm that considers small configurations of polymorphic residues referred to as eplets as essential components of HLA epitopes for analysis. The results showed that 149H, which was the eplet shared by HLA-DRB1 03:01 (from her husband) and DRB1 11:06, DRB1 12:02, DRB3 03:01 (from donor), was the most prevalent eplet on DRB1 reactive alleles in Luminex assay. In conclusion, pretransplant low-level DSAs can induce AMR early after transplantation as a result of shared epitopes with a previous immunizer.
Collapse
Affiliation(s)
- T Mongkolsuk
- Histocompatibility and Immunogenetics Laboratory, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - A Ingsathit
- Department of Pathology, Renal Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Worawichawong
- Immunopathology Laboratory, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Jirasiritham
- Vascular and Transplantation Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - P Kitpoka
- Histocompatibility and Immunogenetics Laboratory, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - D Thammanichanond
- Histocompatibility and Immunogenetics Laboratory, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
18
|
Thammanichanond D, Mongkolsuk T, Rattanasiri S, Kantachuvesiri S, Worawichawong S, Jirasiritham S, Kitpoka P. Significance of C1q-fixing Donor-Specific Antibodies After Kidney Transplantation. Transplant Proc 2014; 46:368-71. [DOI: 10.1016/j.transproceed.2013.11.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/07/2013] [Indexed: 01/21/2023]
|
19
|
Arnold ML, Heinemann FM, Horn P, Ziemann M, Lachmann N, Mühlbacher A, Dick A, Ender A, Thammanichanond D, Fischer GF, Schaub S, Hallensleben M, Mytilineos J, Hitzler WE, Seidl C, Doxiadis IIN, Spriewald BM. 16(th) IHIW: anti-HLA alloantibodies of the of IgA isotype in re-transplant candidates. Int J Immunogenet 2012; 40:17-20. [PMID: 23280184 DOI: 10.1111/iji.12032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 11/12/2012] [Accepted: 11/12/2012] [Indexed: 11/30/2022]
Abstract
In this multicentre study, sera from 803 retransplant candidates, including 775 kidney transplant recipients, were analysed with regard to the presence and specificity of anti-HLA alloantibodies of the IgA isotype using a modified microsphere-based platform. Of the kidney recipients, nearly one-third (n = 237, 31%) had IgA alloantibodies. Mostly, these antibodies were found in sera that also harboured IgG alloantibodies that could be found in a total of 572 (74%) of patients. Interestingly, IgA anti-HLA antibodies were preferentially targeting HLA class I antigens in contrast to those of the IgG isotype, which targeted mostly both HLA class I and II antigens. Donor specificity of the IgA alloantibodies could be established for over half of the 237 patients with IgA alloantibodies (n = 124, 52%). A further 58 patients had specificities against HLA-C or HLA-DP, for which no information regarding donor typing was available. In summary, these data showed in a large cohort of retransplant candidates that IgA alloantibodies occur in about one-third of patients, about half of these antibodies being donor specific.
Collapse
Affiliation(s)
- M-L Arnold
- Deptartment of Internal Medicine 3, University Erlangen-Nürnberg, Erlangen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Thammanichanond D, Ingsathit A, Mongkolsuk T, Rattanasiri S, Kantachuvesiri S, Sakhonrat C, Leenanupan C, Worawichawongs S, Kitpoka P. Pre-transplant donor specific antibody and its clinical significance in kidney transplantation. Asian Pac J Allergy Immunol 2012; 30:48-54. [PMID: 22523907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The traditional method for assessing HLA antibodies in recipient serum samples is the complement-dependent cytotoxicity testing (CDC). Recently, the highly sensitive microbead-based Luminex assay was introduced and can detect low levels of anti-HLA Abs. OBJECTIVE To determine the impact of pretransplant donor-specific HLA antibodies (DSA) detectable by Luminex, despite a negative CDC crossmatch, on the outcomes of kidney transplantation. The correlation and cut-off value of panel reactive antibody (PRA) and DSA was also evaluated. METHODS Pre-transplant sera from 116 kidney transplant recipients with a negative CDC crossmatch were assessed for donor-specific HLA antibodies by using Luminex single antigen beads. The patients received kidney transplants at Ramathibodi Hospital between January 2003 and December 2007. The results were correlated with kidney graft outcomes. RESULTS DSA were found in 24.1% (28/116) of all recipients. Of the twenty-eight DSA positive patients, four developed antibody-mediated rejection (AMR) (4/28 = 14.3%). All these 4 patients had positive C4d staining in their biopsies. Of the eighty-eight DSA negative patients, two developed AMR (2/88 = 2.3%). The AMR occurred more frequently in the DSA positive group than in the DSA negative group (14.3% versus 2.3%. The patient and graft survival were similar in both groups. The strength of pre-transplant DSA was not associated with the incidence of rejection episodes. CONCLUSION There was a higher incidence of AMR in patients with pre-transplant DSA despite a negative CDC crossmatch. However, pre-transplant DSA detected by Luminex had no statistically significant impact on delayed graft function, patient survival and graft survival.
Collapse
Affiliation(s)
- Duangtawan Thammanichanond
- Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Tammakorn C, Mongkolsuk T, Thammanichanond D, Pakakasama S, Kitpoka P. Distribution of killer cell immunoglobulin-like receptor genes in Thai blood donors. J Med Assoc Thai 2011; 94:738-742. [PMID: 21696085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Killer cell Immunoglobulin-like Receptors (KIRs) are members of a group of molecules expressed on the surfaces of natural killer (NK) cells and some T cells. KIRs recognize MHC class I molecules on target cells. The interaction of these molecules regulates NK cell reactivity. The KIR gene cluster is highly polymorphic in individuals and different populations. OBJECTIVE Determine the frequencies and diversities of KIR genes among the Thai population. RESULTS Seventeen KIR genes and common subtypes were identified in 500 healthy Thai blood donors by PCR-SSP. The framework genes KIR2DL4, KIR3DL2, KIR3DL3, and KIR3DP1 were present in all individuals (100%). The observed frequencies of KIR genes vary in the presented population. The most frequent non-framework KIR gene was KIR2DLI (98.4%) while the least frequent was KIR2DL5B (24.2%). CONCLUSION It was observed that the Thai population shows polymorphism of the KIR genes and the diversities of KIR genes in Thai differed from other populations. These data might be of benefit to future studies of the KIR gene and its association with diseases.
Collapse
Affiliation(s)
- Chutima Tammakorn
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | |
Collapse
|
22
|
Miles JJ, Thammanichanond D, Moneer S, Nivarthi UK, Kjer-Nielsen L, Tracy SL, Aitken CK, Brennan RM, Zeng W, Marquart L, Jackson D, Burrows SR, Bowden DS, Torresi J, Hellard M, Rossjohn J, McCluskey J, Bharadwaj M. Antigen-driven patterns of TCR bias are shared across diverse outcomes of human hepatitis C virus infection. J Immunol 2010; 186:901-12. [PMID: 21160049 DOI: 10.4049/jimmunol.1003167] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis C virus (HCV) infection causes significant morbidity and mortality worldwide. T cells play a central role in HCV clearance; however, there is currently little understanding of whether the disease outcome in HCV infection is influenced by the choice of TCR repertoire. TCR repertoires used against two immunodominant HCV determinants--the highly polymorphic, HLA-B*0801 restricted (1395)HSKKKCDEL(1403) (HSK) and the comparatively conserved, HLA-A*0101-restricted, (1435)ATDALMTGY(1443) (ATD)--were analyzed in clearly defined cohorts of HLA-matched, HCV-infected individuals with persistent infection and HCV clearance. In comparison with ATD, TCR repertoire selected against HSK was more narrowly focused, supporting reports of mutational escape in this epitope, in persistent HCV infection. Notwithstanding the Ag-driven divergence, T cell repertoire selection against either Ag was comparable in subjects with diverse disease outcomes. Biased T cell repertoires were observed early in infection and were evident not only in persistently infected individuals but also in subjects with HCV clearance, suggesting that these are not exclusively characteristic of viral persistence. Comprehensive clonal analysis of Ag-specific T cells revealed widespread use of public TCRs displaying a high degree of predictability in TRBV/TRBJ gene usage, CDR3 length, and amino acid composition. These public TCRs were observed against both ATD and HSK and were shared across diverse disease outcomes. Collectively, these observations indicate that repertoire diversity rather than particular Vβ segments are better associated with HCV persistence/clearance in humans. Notably, many of the anti-HCV TCRs switched TRBV and TRBJ genes around a conserved, N nucleotide-encoded CDR3 core, revealing TCR sequence mosaicism as a potential host mechanism to combat this highly variant virus.
Collapse
Affiliation(s)
- John J Miles
- Queensland Institute of Medical Research, Queensland 4029, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Bharadwaj M, Thammanichanond D, Aitken CK, Moneer S, Drummer HE, Tracy S, Holdsworth R, Bowden S, Jackson D, Hellard M, Torresi J, McCluskey J. T
CD8
response in diverse outcomes of recurrent exposure to hepatitis C virus. Immunol Cell Biol 2009; 87:464-72. [DOI: 10.1038/icb.2009.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Mandvi Bharadwaj
- Department of Microbiology and Immunology, University of Melbourne Parkville Victoria Australia
| | | | - Campbell Kynoch Aitken
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health Melbourne Australia
| | - Sarah Moneer
- Department of Microbiology and Immunology, University of Melbourne Parkville Victoria Australia
| | - Heidi E Drummer
- Centre for Virology, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia; Department of Microbiology, Monash University Clayton Australia
| | - Samantha Tracy
- Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory North Melbourne Australia
| | - Rhonda Holdsworth
- Victorian Transplantation and Immunogenetics Service, Australian Red Cross Blood Service Melbourne Australia
| | - Scott Bowden
- Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory North Melbourne Australia
| | - David Jackson
- Department of Microbiology and Immunology, University of Melbourne Parkville Victoria Australia
| | - Margaret Hellard
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health Melbourne Australia
| | - Joseph Torresi
- Department of Infectious Diseases, Austin Hospital, The University of Melbourne Heidelberg Australia
| | - James McCluskey
- Department of Microbiology and Immunology, University of Melbourne Parkville Victoria Australia
| |
Collapse
|
24
|
Thammanichanond D, Moneer S, Yotnda P, Aitken C, Earnest-Silveira L, Jackson D, Hellard M, McCluskey J, Torresi J, Bharadwaj M. Fiber-modified recombinant adenoviral constructs encoding hepatitis C virus proteins induce potent HCV-specific T cell response. Clin Immunol 2008; 128:329-39. [PMID: 18524682 DOI: 10.1016/j.clim.2008.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 03/20/2008] [Accepted: 04/07/2008] [Indexed: 10/22/2022]
|
25
|
Thammanichanond D, Kunakorn M, Settaudom C, Khupulsup K. Reversed passive hemagglutination test fails to detect HBsAg in a number of HBeAg positive sera. Asian Pac J Allergy Immunol 2002; 20:135-7. [PMID: 12403199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
In endemic areas of hepatitis B virus (HBV) infection, perinatal transmission from asymptomatic HBsAg carrier mothers to infants plays a major role in the transmission of HBV. HBeAg indicates a high level of viral replication and infectivity. Most of the infants born to HBeAg positive mothers become carriers. Prenatal screening of HBsAg would identify infected mothers and thus allow preventive administration of immunoglobulin and immunization to the newborns. Reversed passive hemagglutination assay (RPHA) is commonly used in Thailand for HBsAg screening. However this method has low sensitivity and gives false negative results. Therefore, infants born to HBsAg false negative mothers would not receive proper immunization. This study reveals the rate of false negative results for HBsAg by RPHA in high infectivity sera. Of 985 sera which were HBsAg positive by ELISA, 70 (7.1%) were negative for HBsAg by RPHA. Of these 70 false negative sera, 7 (10%) were HBeAg positive. Our results indicate that RPHA is a less sensitive method for detection of HBsAg than ELISA. RPHA can give false negative results even in sera with high HBV infectivity. Therefore, RPHA should be replaced by EIA for prenatal HBsAg screening or any other screening for HBV infection whenever possible.
Collapse
Affiliation(s)
- Duangtawan Thammanichanond
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | |
Collapse
|