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Bray RA, Morris AB, Sullivan HC, Gebel HM. The Virtual Crossmatch: What's in a Name? Transplantation 2023; 107:e273. [PMID: 37749816 DOI: 10.1097/tp.0000000000004723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Affiliation(s)
- Robert A Bray
- Department of Pathology, Emory University, Atlanta, GA
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2
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O’Leary JG, Farris AB, Gebel HM, Asrani SK, Askar M, Garcia V, Snipes GJ, Lo DJ, Knechtle SJ, Klintmalm GB, Demetris AJ. Detailed Analysis of Simultaneous Renal and Liver Allografts in the Presence of DSA. Transplant Direct 2023; 9:e1500. [PMID: 37456590 PMCID: PMC10348731 DOI: 10.1097/txd.0000000000001500] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 07/18/2023] Open
Abstract
Liver allografts protect renal allografts from the same donor from some, but not all, preformed donor specific alloantibodies (DSA). However, the precise mechanisms of protection and the potential for more subtle alterations/injuries within the grafts resulting from DSA interactions require further study. Methods We reevaluated allograft biopsies from simultaneous liver-kidney transplant recipients who had both allografts biopsied within 60 d of one another and within 30 d of DSA being positive in serum (positive: mean florescence intensity ≥5000). Routine histology, C4d staining, and specialized immunohistochemistry for Kupffer cells (KCs; CD163) and a C4d receptor immunoglobulin-like transcript-4 were carried out in 4 patients with 6 paired biopsies. Results Overt antibody-mediated rejection was found in 3 of 4 renal and liver allografts. One patient had biopsy-confirmed renal and liver allograft antibody-mediated rejection despite serum clearance of DSA. All biopsies showed KC hypertrophy (minimal: 1; mild: 2; moderate: 1; severe: 2) and cytoplasmic C4d KC staining was easily detected in 2 biopsies from 2 patients; minimal and negative in 2 biopsies each. Implications of which are discussed. Control 1-y protocol liver allograft biopsies from DSA- recipients showed neither KC hypertrophy nor KC C4d staining (n = 6). Conclusions Partial renal allograft protection by a liver allograft from the same donor may be partially mediated by phagocytosis/elimination of antibody and complement split products by KCs, as shown decades ago in controlled sensitized experimental animal experiments.
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Affiliation(s)
| | - Alton B. Farris
- Department of Pathology, Emory University Hospital, Atlanta, GA
| | - Howard M. Gebel
- Department of Pathology, Emory University Hospital, Atlanta, GA
| | - Sumeet K. Asrani
- Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas TX
| | - Medhat Askar
- Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas TX
| | - Vanessa Garcia
- Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas TX
| | - George J. Snipes
- Department of Pathology, Baylor University Medical Center, Dallas TX
| | - Denise J. Lo
- Department of Surgery, Duke University, Durham, NC
| | | | - Goran B. Klintmalm
- Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas TX
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3
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Roll GR, Bray RA, Cooper M, Eagar TN, Gebel HM, Vranic GM, Hitchman KM, Houp J, Kamoun M, Killian J, Kim J, Kumar V, Levine M, Lovasik BP, Lunow-Luke T, Parsons RF, Pattanayak V, Ranch D, Shah A, Stock PG, Timofeeva OA, Trofe-Clark J, Wongjirad C, Yeh H, Yi S, Rajalingam R. COVID-19 infection and vaccination rarely impact HLA antibody profile in waitlisted renal transplant Candidates- a multicenter cohort. Hum Immunol 2023; 84:278-285. [PMID: 36868898 PMCID: PMC9946887 DOI: 10.1016/j.humimm.2023.02.005] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
Although rare, infection and vaccination can result in antibodies to human leukocyte antigens (HLA). We analyzed the effect of SARS-CoV-2 infection or vaccination on HLA antibodies in waitlisted renal transplant candidates. Specificities were collected and adjudicated if the calculated panel reactive antibodies (cPRA) changed after exposure. Of 409 patients, 285 (69.7 %) had an initial cPRA of 0 %, and 56 (13.7 %) had an initial cPRA > 80 %. The cPRA changed in 26 patients (6.4 %), 16 (3.9 %) increased, and 10 (2.4 %) decreased. Based on cPRA adjudication, cPRA differences generally resulted from a small number of specificities with subtle fluctuations around the borderline of the participating centers' cutoff for unacceptable antigen listing. All five COVID recovered patients with an increased cPRA were female (p = 0.02). In summary, exposure to this virus or vaccine does not increase HLA antibody specificities and their MFI in approximately 99 % of cases and 97 % of sensitized patients. These results have implications for virtual crossmatching at the time of organ offer after SARS-CoV-2 infection or vaccination, and these events of unclear clinical significance should not influence vaccination programs.
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Affiliation(s)
- Garrett R. Roll
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Robert A. Bray
- Histocompatibility and Molecular Immunogenetics Laboratory, Emory University, Atlanta, GA, United States
| | - Matthew Cooper
- Medstar-Georgetown Transplant Institute, Washington, DC, United States
| | - Todd N. Eagar
- Immunogenetics and Transplantation Laboratory Houston Methodist, Houston, TX, United States
| | - Howard M. Gebel
- Histocompatibility and Molecular Immunogenetics Laboratory, Emory University, Atlanta, GA, United States
| | - Gayle M. Vranic
- Medstar-Georgetown Transplant Institute, Washington, DC, United States
| | - Kelley M.K. Hitchman
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, San Antonio, San Antonio, TX, United States
| | - Julie Houp
- Department of Laboratory Medicine, University of Alabama Medical Center, Birmingham, AL, United Kingdom
| | - Malek Kamoun
- Department of Pathology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - John Killian
- Department of Surgery, University of Alabama Medical Center, Birmingham, AL, United Kingdom
| | - Jim Kim
- Department of Surgery, University of Southern California, Los Angeles, CA, United States
| | - Vineeta Kumar
- Department of Medicine, Division of Nephrology, University of Alabama, Birmingham, AL, United Kingdom
| | - Matthew Levine
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - Brendan P. Lovasik
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Tyler Lunow-Luke
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Ronald F. Parsons
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Vikram Pattanayak
- Department of Pathology, Massachusetts General Hospital, Boston MA, United States
| | - Daniel Ranch
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Anushi Shah
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Peter G. Stock
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Olga A. Timofeeva
- Department of Pathology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Jennifer Trofe-Clark
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - Chelsey Wongjirad
- Department of Surgery, University of Southern California, Los Angeles, CA, United States
| | - Heidi Yeh
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Stephanie Yi
- Department of Surgery, Houston Methodist, Houston, TX, United States
| | - Raja Rajalingam
- Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California San Francisco, San Francisco, CA, United States.
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Horwath M, Tvrdik T, Saxe D, Deeb KK, Roback JD, Gebel HM, Bray RA, Sullivan HC. Loss of heterozygosity leading to incorrect HLA typing for platelet-transfusion refractory patient. Transfusion 2023; 63:263-268. [PMID: 36426572 DOI: 10.1111/trf.17189] [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: 03/18/2022] [Revised: 10/11/2022] [Accepted: 10/15/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Management of platelet-transfusion refractory (PR) patients due to anti-HLA antibodies includes the provision of HLA-matched (HLAm) platelets (PLT) or PLTs that are negative for HLA antigens corresponding to the recipient antibodies. Obtaining HLAm PLTs is predicated on accurate HLA antigen typing of the recipient and donor. Here, we present the clinical implications of a case involving loss of heterozygosity (LOH) in a patient presented for PR workup. STUDY DESIGN AND METHODS HLA typing was performed by three methods: (1) Real-time PCR; (2) Sequence-specific oligonucleotide (SSO) typing test; and (3) Next-Generation Sequencing (NGS). Cytogenomic SNP microarray was utilized to assess LOH. RESULTS A 30-year-old female with newly diagnosed acute myelogenous leukemia was found to be PR secondary to HLA sensitization. A peripheral blood (PB) sample, containing 93% myeloid blast cells, was sent for HLA typing for the provision of HLAm PLTs. HLA typing revealed homozygosity at the HLA-A locus but was heterozygous at the -B and -C loci. After chemotherapy, HLA typing on a new PB sample, devoid of blast cells, identified HLA-A locus heterozygosity, which was subsequently confirmed by real-time PCR and NGS. Cytogenomic SNP microarray analysis demonstrated LOH of the HLA-A locus on chromosome 6p in the pretreatment sample but not in the posttreatment sample. CONCLUSION In hematologic patients with high tumor burden, HLA homozygosity should be viewed with suspicion for potential LOH. Therefore, HLA testing should be repeated, preferably with a non-hematological source (e.g., buccal swab) or following successful reduction of the tumor burden.
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Affiliation(s)
- Michael Horwath
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tatiana Tvrdik
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Debra Saxe
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kristin K Deeb
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John D Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Howard M Gebel
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert A Bray
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Harold Clifford Sullivan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Tambur AR, Bestard O, Campbell P, Chong AS, Barrio MC, Ford ML, Gebel HM, Heidt S, Hickey M, Jackson A, Kosmoliaptsis V, Lefaucheur C, Louis K, Mannon RB, Mengel M, Morris A, Pinelli DF, Reed EF, Schinstock C, Taupin JL, Valenzuela N, Wiebe C, Nickerson P. Sensitization in transplantation: Assessment of Risk 2022 Working Group Meeting Report. Am J Transplant 2023; 23:133-149. [PMID: 36695615 DOI: 10.1016/j.ajt.2022.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 08/22/2022] [Revised: 10/20/2022] [Accepted: 11/02/2022] [Indexed: 01/13/2023]
Abstract
The Sensitization in Transplantation: Assessment of Risk workgroup is a collaborative effort of the American Society of Transplantation and the American Society of Histocompatibility and Immunogenetics that aims at providing recommendations for clinical testing, highlights gaps in current knowledge, and proposes areas for further research to enhance histocompatibility testing in support of solid organ transplantation. This report provides updates on topics discussed by the previous Sensitization in Transplantation: Assessment of Risk working groups and introduces 2 areas of exploration: non-human leukocyte antigen antibodies and utilization of human leukocyte antigen antibody testing measurement to evaluate the efficacy of antibody-removal therapies.
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Affiliation(s)
- Anat R Tambur
- Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, Illinois, USA.
| | - Oriol Bestard
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Patricia Campbell
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Canada
| | - Anita S Chong
- Section of Transplantation, Department of Surgery, The University of Chicago, Chicago, Illinois, USA
| | - Martha Crespo Barrio
- Department of Nephrology, Hospital del Mar & Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Mandy L Ford
- Department of Surgery and Emory Transplant Center, Emory University, Atlanta, Georgia, USA
| | - Howard M Gebel
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sebastiaan Heidt
- Department of Immunology, Leiden University Medical Center, Netherlands
| | - Michelle Hickey
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Annette Jackson
- Department of Immunology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Carmen Lefaucheur
- Paris Translational Research Center for Organ Transplantation, Institut national de la santé et de la recherche médicale UMR-S970, Université de Paris, Paris, France
| | - Kevin Louis
- Paris Translational Research Center for Organ Transplantation, Institut national de la santé et de la recherche médicale UMR-S970, Université de Paris, Paris, France
| | - Roslyn B Mannon
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Michael Mengel
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Canada
| | - Anna Morris
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David F Pinelli
- Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, Illinois, USA
| | - Elaine F Reed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Jean-Luc Taupin
- Department of Immunology, Saint Louis Hospital and University Paris-Cité, Paris, France
| | - Nicole Valenzuela
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Chris Wiebe
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter Nickerson
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Gragert L, Kadatz M, Alcorn J, Stewart D, Chang D, Gill J, Liwski R, Gebel HM, Gill J, Lan JH. ABO-adjusted calculated panel reactive antibody (cPRA): A unified metric for immunologic compatibility in kidney transplantation. Am J Transplant 2022; 22:3093-3100. [PMID: 35975734 PMCID: PMC10087664 DOI: 10.1111/ajt.17175] [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: 05/26/2022] [Revised: 07/17/2022] [Accepted: 08/13/2022] [Indexed: 01/25/2023]
Abstract
Implementation of the kidney allocation system in 2014 greatly reduced access disparity due to human leukocyte antigen (HLA) sensitization. To address persistent disparity related to candidate ABO blood groups, herein we propose a novel metric termed "ABO-adjusted cPRA," which simultaneously considers the impact of candidate HLA and ABO sensitization on the same scale. An ethnic-weighted ABO-adjusted cPRA value was computed for 190 467 candidates on the kidney waitlist by combining candidate's conventional HLA cPRA with the remaining fraction of HLA-compatible donors that are ABO-incompatible. Consideration of ABO sensitization resulted in higher ABO-adjusted cPRA relative to conventional cPRA by HLA alone, except for AB candidates since they are not ABO-sensitized. Within cPRA Point Group = 99%, 43% of the candidates moved up to ABO-adjusted cPRA Point Group = 100%, though this proportion varied substantially by candidate blood group. Nearly all O and most B candidates would have elevated ABO-adjusted cPRA values above this policy threshold for allocation priority, but relatively few A candidates displayed this shift. Overall, ABO-adjusted cPRA more accurately measures the proportion of immune-compatible donors compared with conventional HLA cPRA, especially for highly sensitized candidates. Implementation of this novel metric could enable the development of allocation policies permitting more ABO-compatible transplants without compromising equity.
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Affiliation(s)
- Loren Gragert
- Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Matthew Kadatz
- Vancouver Coastal Health Research Institute, Vancouver, Canada.,Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - James Alcorn
- United Network for Organ Sharing, Richmond, Virginia, USA
| | - Darren Stewart
- United Network for Organ Sharing, Richmond, Virginia, USA
| | - Doris Chang
- Providence Health Research Institute, Vancouver, Canada
| | - Jagbir Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada.,Providence Health Research Institute, Vancouver, Canada.,Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada
| | - Robert Liwski
- Department of Pathology, Dalhousie University, Halifax, Canada
| | - Howard M Gebel
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - John Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada.,Providence Health Research Institute, Vancouver, Canada
| | - James H Lan
- Vancouver Coastal Health Research Institute, Vancouver, Canada.,Division of Nephrology, University of British Columbia, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
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Lemieux W, Fleischer D, Yang AY, Niemann M, Oualkacha K, Klement W, Richard L, Polychronakos C, Liwski R, Claas F, Gebel HM, Keown PA, Lewin A, Sapir-Pichhadze R. Dissecting the impact of molecular T-cell HLA mismatches in kidney transplant failure: A retrospective cohort study. Front Immunol 2022; 13:1067075. [PMID: 36505483 PMCID: PMC9730505 DOI: 10.3389/fimmu.2022.1067075] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Kidney transplantation is the optimal treatment in end-stage kidney disease, but de-novo donor specific antibody development continues to negatively impact patients undergoing kidney transplantation. One of the recent advances in solid organ transplantation has been the definition of molecular mismatching between donors and recipients' Human Leukocyte Antigens (HLA). While not fully integrated in standard clinical care, cumulative molecular mismatch at the level of eplets (EMM) as well as the PIRCHE-II score have shown promise in predicting transplant outcomes. In this manuscript, we sought to study whether certain T-cell molecular mismatches (TcEMM) were highly predictive of death-censored graft failure (DCGF). Methods We studied a retrospective cohort of kidney donor:recipient pairs from the Scientific Registry of Transplant Recipients (2000-2015). Allele level HLA-A, B, C, DRB1 and DQB1 types were imputed from serologic types using the NMDP algorithm. TcEMMs were then estimated using the PIRCHE-II algorithm. Multivariable Accelerated Failure Time (AFT) models assessed the association between each TcEMM and DCGF. To discriminate between TcEMMs most predictive of DCGF, we fit multivariable Lasso penalized regression models. We identified co-expressed TcEMMs using weighted correlation network analysis (WGCNA). Finally, we conducted sensitivity analyses to address PIRCHE and IMGT/HLA version updates. Results A total of 118,309 donor:recipient pairs meeting the eligibility criteria were studied. When applying the PIRCHE-II algorithm, we identified 1,935 distinct TcEMMs at the population level. A total of 218 of the observed TcEMM were independently associated with DCGF by AFT models. The Lasso penalized regression model with post selection inference identified a smaller subset of 86 TcEMMs (56 and 30 TcEMM derived from HLA Class I and II, respectively) to be highly predictive of DCGF. Of the observed TcEMM, 38.14% appeared as profiles of highly co-expressed TcEMMs. In addition, sensitivity analyses identified that the selected TcEMM were congruent across IMGT/HLA versions. Conclusion In this study, we identified subsets of TcEMMs highly predictive of DCGF and profiles of co-expressed mismatches. Experimental verification of these TcEMMs determining immune responses and how they may interact with EMM as predictors of transplant outcomes would justify their consideration in organ allocation schemes and for modifying immunosuppression regimens.
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Affiliation(s)
- William Lemieux
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Centre, Montréal, QC, Canada,Medical Affairs & Innovation, Héma-Québec, Montréal, QC, Canada
| | - David Fleischer
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | - Archer Yi Yang
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | | | - Karim Oualkacha
- Department of Mathematics, Université du Québec à Montreal, Montreal, QC, Canada
| | - William Klement
- Division of Organ Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Lucie Richard
- Transfusion medicine/Reference Laboratory, Héma-Québec, Montréal, QC, Canada
| | - Constantin Polychronakos
- Department of Pediatrics, The Research Institute of the McGill University Health Centre and the Montreal Children’s Hospital, Montréal, QC, Canada
| | - Robert Liwski
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Frans Claas
- Department of Immunology, Leiden University Medical Centre, Leiden, Netherlands
| | - Howard M. Gebel
- Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
| | - Paul A. Keown
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Antoine Lewin
- Medical Affairs & Innovation, Héma-Québec, Montréal, QC, Canada,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Centre, Montréal, QC, Canada,Division of Nephrology and the Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada,*Correspondence: Ruth Sapir-Pichhadze,
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8
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Morris AB, Bray R, Gebel HM, Cliff Sullivan H. A Primer on Chimerism Analysis: A Straightforward, Thorough Review. Lab Med 2022:6827470. [DOI: 10.1093/labmed/lmac132] [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] [Indexed: 11/15/2022] Open
Abstract
Abstract
Short tandem repeat (STR) analysis to assess chimerism is a critical aspect of routine care particularly in patients facing stem cell transplants but is also relevant in other clinical scenarios. STR analysis provides a means to assess donor and recipient cellular origins in a patient, and, as such, can inform engraftment, rejection, and relapse status in stem cell transplant recipients. In this review of STR testing, the most commonly used method to assess chimerism, its background, procedural details, and clinical utility are discussed.
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Affiliation(s)
- Anna B Morris
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Robert Bray
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Howard M Gebel
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - H Cliff Sullivan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
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9
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Dent EA, Duncan A, Sullivan HC, Gebel HM, Bray RA, Maier CL, Smith G, Guarner J. Establishing a combined Immunology/HLA/Coagulation Rotation for Pathology Residents. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.007] [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] [Indexed: 11/11/2022] Open
Abstract
Abstract
Given the breath of subspecialties within Clinical Pathology (CP), creating a curriculum with adequate exposure to all areas is challenging. Immunology, coagulation, and HLA rotations have been cited repeatedly by pathology trainees at our institution as targets for improvement. To address these concerns, a combined immunology/ HLA/ coagulation rotation was implemented wherein trainees spend a month exploring testing methods and their interpretations in each of these three different specialized laboratory sections. Herein, we describe the experience of the first 7 trainees (approximately the size of one residency class in our institution) who completed the newly implemented rotation. The rotation combines didactic lectures, assigned reading, time at the bench (to observe procedures), online modules, and case study discussions in each of the areas. The goal was to compare and contrast related concepts/techniques across lab sections. The month is divided so that residents spend the mornings of the first two weeks in HLA, the mornings of the third week in coagulation, and the mornings of the fourth week in immunology. Residents spend afternoons completing assignments and providing narrative interpretations for coagulation tests (such as the Lupus Anticoagulant/Antiphospholipid Antibody test) that they then review with attending physicians. Residents were assessed at the beginning and end of the rotation for their medical knowledge in each area. Additionally, they were provided the opportunity to share their expectations and evaluations of the rotation at its onset and completion, respectively. There was a significant increase in average scores when comparing pre- and post-rotation assessments (46% compared to 78%; p < 0.01) of medical knowledge. Overall, trainees ranked the rotation 4.25 in a Likert scale of 5 and favored the asynchronous eLearning modules (4.7) over discussions in signout (4.29), in person case review (4.43), and assigned reading (4.0). Residents were also asked to rank their comfort in generating reports within each section; they felt more confident with Coagulation profiles (2.86 in a Likert scale out of 3) compared to ANA patterns (2.29) or interpreting HLA results (1.86). Residents described the rotation as “very useful” and “challenging.” Learners cited signing out coagulation cases and exposure to the HLA lab as highlights of the rotation. Coordinating individual schedules across three lab sections was a persistent challenge for trainees. In conclusion, we implemented a new CP rotation combining Coagulation, HLA, and Immunology topics into one month-long rotation. Evaluation of trainees to-date demonstrated an increase in medical knowledge post-rotation compared to pre-rotation, and an overall satisfaction with the rotation based on their feedback. HLA learning modules were restructured in response to limited confidence in HLA report interpretation. Based on the success of the combined rotation, it will become a permanent component of the CP curriculum for all residents.
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Affiliation(s)
- Edward A Dent
- Department of Pathology and Laboratory Medicine, Emory University
| | - Alexander Duncan
- Department of Pathology and Laboratory Medicine, Emory University
| | - H Cliff Sullivan
- Department of Pathology and Laboratory Medicine, Emory University
| | - Howard M Gebel
- Department of Pathology and Laboratory Medicine, Emory University
| | - Robert A Bray
- Department of Pathology and Laboratory Medicine, Emory University
| | - Cheryl L Maier
- Department of Pathology and Laboratory Medicine, Emory University
| | - Geoffrey Smith
- Department of Pathology and Laboratory Medicine, Emory University
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10
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Girnita AL, Wang L, Colovai AI, Ahearn P, Azzi Y, Menon MC, Fernandez-Vina M, Gebel HM, Steve Woodle E, Cravedi P, Maltzman JS, Akalin E. Analysis of Cross-sectional and Longitudinal HLA and Anti-viral Responses After COVID Infection in Renal Allograft Recipients: Differences and Correlates. Transplantation 2022; 106:2085-2091. [PMID: 36070571 PMCID: PMC9521392 DOI: 10.1097/tp.0000000000004277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Characterization of anti-HLA versus anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) immune globulin isotypes in organ transplant recipients after coronavirus disease 2019 (COVID-19) infection has not been reported. We aimed to determine changes in anti-HLA antibodies in renal transplant patients with COVID-19 and compare the immunoglobulin and epitope-binding pattern versus anti-SARS-CoV-2 antibodies. METHODS This is a cross-sectional study of 46 kidney transplant recipients including 21 with longitudinal sampling. Using a semi-quantitative multiplex assay, we determined immunoglobulin (Ig) M, IgA, IgG, and IgG1-2-3-4 antibodies against Class I and Class II HLA, and 5 SARS-CoV-2 epitopes including the nucleocapsid protein and multiple regions of the spike protein. RESULTS Fourteen of 46 (30%) patients had donor-specific anti-HLA antibodies (donor-specific antibody [DSA]), 12 (26%) had non-DSA anti-HLA antibodies and 45 (98%) had anti-SARS-CoV-2 antibodies. Most DSAs targeted HLA-DQ (71%), with a dominant IgG isotype and IgG1 subtype prevalence (93%), and/or IgG3 (64%), followed by IgG2 (36%). Comparatively, there was a higher prevalence of IgA (85% versus 14%, P = 0.0001) and IgM (87%, versus 36%, P = 0.001) in the anti-SARS-CoV-2 antibody profile, when compared to DSAs, respectively. Anti-SARS-CoV-2 antibody profile was characterized by increased prevalence of IgM and IgA, when compared to DSAs. The median calculated panel reactive antibody before COVID-19 diagnosis (24%) tended to decrease after COVID-19 diagnosis (10%) but it was not statistically significant ( P = 0.1). CONCLUSIONS Anti-HLA antibody strength and calculated panel reactive antibody in kidney transplant recipients after COVID-19 do not significantly increase after infection. Although the IgG isotype was the dominant form in both HLA and SARS-CoV-2 antigens, the alloimmune response had a low IgA pattern, whereas anti-SARS-CoV-2 antibodies were high IgA/IgM.
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Affiliation(s)
- Alin L. Girnita
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA
| | - Lin Wang
- Department of Pathology, Histocompatibility and Immunogenetics Laboratory, Stanford Blood Center, Palo Alto, CA
| | - Adriana I. Colovai
- Department of Transplantation, Kidney Transplant Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Patrick Ahearn
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Yorg Azzi
- Department of Transplantation, Kidney Transplant Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Madhav C. Menon
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA
- Department of Medicine, Division of Nephrology, Yale University School of Medicine, New Haven, CT
| | | | | | - E. Steve Woodle
- Department of Surgery, University of Cincinnati, Cincinnati, OH
| | - Paolo Cravedi
- Department of Medicine, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jonathan S. Maltzman
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
- Department of Internal Medicine, Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA
| | - Enver Akalin
- Department of Transplantation, Kidney Transplant Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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11
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McCune TR, Bray RA, Baran DA, Toepp AJ, Forte SJ, Gilgannon LT, Williams T, Chen S, Sadr H, Gebel HM, Herre JM. Development of donor specific antibodies after SARS-CoV-2 vaccination in kidney and heart transplant recipients. Transpl Immunol 2022; 75:101722. [PMID: 36152939 PMCID: PMC9492402 DOI: 10.1016/j.trim.2022.101722] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022]
Abstract
This study examined the development of new or changes in donor specific antibodies (DSA) mean-fluorescence intensity (MFI) after SARS-CoV-2 vaccination in 100 kidney and 50 heart transplant recipients. The study was performed when the Center for Disease Control and Prevention (CDC) recommended two doses of Pfizer/BioNTech [BNT162b2] and Moderna [mRNA-1273 SARS-CoV-2] vaccine or 1 dose Johnson & Johnson/Janssen [Ad26.COV2·S] vaccines for full vaccination in transplant recipients. A novel assay bead-based platform for detecting antibodies against 4 domains of the SARS-CoV-2 spike protein to determine vaccine response (SA) and one nucleocapsid protein (NC) to determine prior SARS-CoV-2 infection was utilized. These assays were performed on the multiplex, bead-based platform utilized to assay DSA levels. 61/150 patients (40.7%) had successful vaccination. 18 patients had confirmed SARS-CoV-2 infection based on positive NC assay or previous Covid-19 oropharyngeal swab. 138 patients had no DSA prior to vaccination but 3 heart recipients developed new DSA's. Among 12 patients with known DSA prior to vaccination, 4 developed new DSA's or increased MFI. All 7 patients with new or increased DSA had stable graft function without rejection and had no changes in immunosuppression. All 8 patients with stable post vaccine DSA had stable graft function and immunosuppression was not changed. The presence of DSA before vaccination was associated with subsequent development of increased MFI or new DSA's (p = 0.001). There was no association between pre-vaccine DSA and positive vaccine response (NS). There was no association with successful vaccination or prior SARS-CoV-2 infection and DSA changes (NS).
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Affiliation(s)
- Thomas R McCune
- Eastern Virginia Medical School, Division of Nephrology, Norfolk, VA 23501-1980, USA; Sentara Norfolk General Hospital, Kidney/Pancreas Transplant Program, Norfolk, VA 23507, USA; Eastern Virginia Medical School, Department of Internal Medicine, Norfolk, VA 23501-1980, USA.
| | - Robert A Bray
- Emory Univ Hosp, Dept of Pathology Rm F149, 1364 Clifton Rd NE, Atlanta, GA 30322, USA.
| | - David A Baran
- Eastern Virginia Medical School, Division of Cardiology, Norfolk, VA 23501-1980, USA; Sentara Norfolk General Hospital, Advanced Heart Failure and Transplantation, Norfolk, VA 23507-1999, USA; Eastern Virginia Medical School, Department of Internal Medicine, Norfolk, VA 23501-1980, USA
| | - Angela J Toepp
- Sentara Healthcare, Quality Research Institute, Virginia Beach, VA 23462, USA; Enterprise Analytics, Sentara Healthcare, Norfolk, VA 23501, USA.
| | - Steven J Forte
- Eastern Virginia Medical School, School of Medicine, Norfolk, VA 23501-1980, USA.
| | - Lauren T Gilgannon
- Eastern Virginia Medical School, School of Medicine, Norfolk, VA 23501-1980, USA.
| | - Troy Williams
- Enterprise Analytics, Sentara Healthcare, Norfolk, VA 23501, USA.
| | - Shirui Chen
- Eastern Virginia Medical School, Division of Nephrology, Norfolk, VA 23501-1980, USA
| | - Hooman Sadr
- Sentara Norfolk General Hospital, Kidney/Pancreas Transplant Program, Norfolk, VA 23507, USA
| | - Howard M Gebel
- Emory Univ Hosp, Dept of Pathology Rm F149, 1364 Clifton Rd NE, Atlanta, GA 30322, USA.
| | - John M Herre
- Eastern Virginia Medical School, Division of Cardiology, Norfolk, VA 23501-1980, USA; Sentara Norfolk General Hospital, Advanced Heart Failure and Transplantation, Norfolk, VA 23507-1999, USA; Eastern Virginia Medical School, Department of Internal Medicine, Norfolk, VA 23501-1980, USA.
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12
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Wade J, Roback JD, Krummey SM, Gebel HM, Bray RA, Sullivan HC. Implementing virtual crossmatch based diagnostic management teams in human leukocyte antigen laboratories and transplant programs. Transpl Immunol 2022; 73:101629. [DOI: 10.1016/j.trim.2022.101629] [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] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022]
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13
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Affiliation(s)
- Allen J Norin
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
| | - Howard M Gebel
- Department of Pathology, Division of Laboratory Medicine, Emory University Hospital, Atlanta, GA, United States
| | - Malek Kamoun
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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14
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Mehta SA, Reyentovich A, Montgomery RA, Segev DL, Gebel HM, Bray RA, Samanovic MI, Cornelius AR, Mulligan MJ, Herati RS. Immunogenicity after heterologous third dose COVID-19 vaccination in a heart transplant recipient. Clin Transplant 2022; 36:e14605. [PMID: 35107835 DOI: 10.1111/ctr.14605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sapna A Mehta
- New York University Langone Transplant Institute, New York, NY, USA.,New York University Grossman School of Medicine, New York, NY, USA
| | - Alex Reyentovich
- New York University Langone Transplant Institute, New York, NY, USA.,New York University Grossman School of Medicine, New York, NY, USA
| | - Robert A Montgomery
- New York University Langone Transplant Institute, New York, NY, USA.,New York University Grossman School of Medicine, New York, NY, USA
| | - Dorry L Segev
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Howard M Gebel
- Emory University Hospital, Department of Pathology, Atlanta, GA, USA
| | - Robert A Bray
- Emory University Hospital, Department of Pathology, Atlanta, GA, USA
| | - Marie I Samanovic
- New York University Grossman School of Medicine, New York, NY, USA.,New York University Langone Vaccine Center, New York, NY, USA
| | - Amber R Cornelius
- New York University Grossman School of Medicine, New York, NY, USA.,New York University Langone Vaccine Center, New York, NY, USA
| | - Mark J Mulligan
- New York University Grossman School of Medicine, New York, NY, USA.,New York University Langone Vaccine Center, New York, NY, USA
| | - Ramin S Herati
- New York University Grossman School of Medicine, New York, NY, USA.,New York University Langone Vaccine Center, New York, NY, USA
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15
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16
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Cravedi P, Ahearn P, Wang L, Yalamarti T, Hartzell S, Azzi Y, Menon MC, Jain A, Billah M, Fernandez-Vina M, Gebel HM, Woodle ES, Haddad NS, Morrison-Porter A, Lee FEH, Sanz I, Akalin E, Girnita A, Maltzman JS. Delayed Kinetics of IgG, but Not IgA, Antispike Antibodies in Transplant Recipients following SARS-CoV-2 Infection. J Am Soc Nephrol 2021; 32:3221-3230. [PMID: 34599041 PMCID: PMC8638399 DOI: 10.1681/asn.2021040573] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/28/2021] [Accepted: 09/07/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Kidney transplant recipients are at increased risk of severe outcomes during COVID-19. Antibodies against the virus are thought to offer protection, but a thorough characterization of anti-SARS-CoV-2 immune globulin isotypes in kidney transplant recipients following SARS-CoV-2 infection has not been reported. METHODS We performed a cross-sectional study of 49 kidney transplant recipients and 42 immunocompetent controls at early (≤14 days) or late (>14 days) time points after documented SARS-CoV-2 infection. Using a validated semiquantitative Luminex-based multiplex assay, we determined the abundances of IgM, IgG, IgG1-4, and IgA antibodies against five distinct viral epitopes. RESULTS Kidney transplant recipients showed lower levels of total IgG antitrimeric spike (S), S1, S2, and receptor binding domain (RBD) but not nucleocapsid (NC) at early versus late time points after SARS-CoV-2 infection. Early levels of IgG antispike protein epitopes were also lower than in immunocompetent controls. Anti-SARS-CoV-2 antibodies were predominantly IgG1 and IgG3, with modest class switching to IgG2 or IgG4 in either cohort. Later levels of IgG antispike, S1, S2, RBD, and NC did not significantly differ between cohorts. There was no significant difference in the kinetics of either IgM or IgA antispike, S1, RBD, or S2 on the basis of timing after diagnosis or transplant status. CONCLUSIONS Kidney transplant recipients mount early anti-SARS-CoV-2 IgA and IgM responses, whereas IgG responses are delayed compared with immunocompetent individuals. These findings might explain the poor outcomes in transplant recipients with COVID-19. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/JASN/2021_11_23_briggsgriffin112321.mp3.
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Affiliation(s)
- Paolo Cravedi
- Department of Medicine, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Patrick Ahearn
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Lin Wang
- Department of Pathology, Stanford University School of Medicine, Palo Alto, California
| | - Tanuja Yalamarti
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Susan Hartzell
- Department of Medicine, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yorg Azzi
- Department of Medicine, Einstein-Montefiore Abdominal Transplant Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Madhav C. Menon
- Department of Medicine, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Medicine, Division of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Aditya Jain
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marzuq Billah
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - E. Steve Woodle
- Department of Surgery, Division of Transplantation, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Ignacio Sanz
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Enver Akalin
- Department of Medicine, Einstein-Montefiore Abdominal Transplant Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Alin Girnita
- Department of Pathology, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan S. Maltzman
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California,Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
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17
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Krummey SM, Bray RA, Gebel HM, Sullivan HC. Eplet mismatch imputation studies should include immunologic risk assessment. Am J Transplant 2021; 21:3500-3501. [PMID: 33728758 DOI: 10.1111/ajt.16562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/23/2021] [Accepted: 03/05/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Scott M Krummey
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert A Bray
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Howard M Gebel
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Harold C Sullivan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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18
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Woodle ES, Gebel HM, Montgomery RA, Maltzman JS. SARS-CoV-2 Vaccination, Immune Responses, and Antibody Testing in Immunosuppressed Populations: Tip of the Iceberg. Transplantation 2021; 105:1911-1913. [PMID: 34144554 DOI: 10.1097/tp.0000000000003859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- E Steve Woodle
- Division of Transplantation, Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Howard M Gebel
- Division of Laboratory Medicine, Department of Pathology, Emory University, Atlanta, GA
| | - Robert A Montgomery
- New York University Langone Transplant Institute, NYU Langone Health, New York, NY
| | - Jonathan S Maltzman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
- VA Palo Alto Health Care System, Palo Alto, CA
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19
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Woodle ES, Gebel HM, Montgomery RA, Maltzman JS. SARS-CoV-2 Vaccination and Antibody Testing in Immunosuppressed Populations: You Can't Tell the Players Without a Scorecard [RETRACTED]. Transplantation 2021; Publish Ahead of Print:00007890-900000000-95209. [PMID: 34224542 DOI: 10.1097/tp.0000000000003882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- E Steve Woodle
- University of Cincinnati, College of Medicine, Department of Surgery, Division of Transplantation, Cincinnati, OH, USA. Emory University, Department of Pathology, Division of Laboratory Medicine, Atlanta, GA, USA. New York University Langone Transplant Institute, NYU Langone Health, New York, New York, USA. Stanford University School of Medicine, Department of Medicine, and VA Palo Alto Health Care System, Palo Alto, CA, USA
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20
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Sullivan HC, Gebel HM. Hurts So Good: Uncovering the Relationship Between Blood Transfusions and Allograft Outcome. Kidney Int Rep 2021; 6:875-877. [PMID: 33939774 PMCID: PMC8071641 DOI: 10.1016/j.ekir.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Harold C. Sullivan
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Howard M. Gebel
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
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21
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Adam BA, Gebel HM. Borrowing from the past to invest in the future: The AJT editorial fellowship process. Am J Transplant 2021; 21:1343-1344. [PMID: 32905657 DOI: 10.1111/ajt.16306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/07/2020] [Accepted: 08/31/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Benjamin A Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Howard M Gebel
- Department of Pathology, Emory University, Atlanta, Georgia, USA
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22
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Lan JH, Kadatz M, Chang DT, Gill J, Gebel HM, Gill JS. Pretransplant Calculated Panel Reactive Antibody in the Absence of Donor-Specific Antibody and Kidney Allograft Survival. Clin J Am Soc Nephrol 2021; 16:275-283. [PMID: 33495290 PMCID: PMC7863647 DOI: 10.2215/cjn.13640820] [Citation(s) in RCA: 5] [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: 08/19/2020] [Accepted: 12/16/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Panel reactive antibody informs the likelihood of finding an HLA-compatible donor for transplant candidates, but has historically been associated with acute rejection and allograft survival because testing methods could not exclude the presence of concomitant donor-specific antibodies. Despite new methods to exclude donor-specific antibodies, panel reactive antibody continues to be used to determine the choice of induction and maintenance immunosuppression. The study objective was to determine the clinical relevance of panel reactive antibody in the absence of donor-specific antibodies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Retrospective observational study of kidney allograft survival among 4058 zero HLA-A-, B-, DR-, and DQB1-mismatched transplant recipients without antibodies to donor kidney antigens encoded by these HLA gene loci. RESULTS Among 4058 first and repeat transplant recipients, patients with calculated panel reactive antibody (cPRA) 1%-97% were not at higher risk of transplant failure, compared with patients with cPRA of 0% (death censored graft loss: hazard ratio, 1.07; 95% confidence interval, 0.82 to 1.41). Patients with cPRA ≥98% had a higher risk of graft loss from any cause including death (hazard ratio, 1.39; 95% confidence interval, 1.08 to 1.79) and death censored allograft failure (hazard ratio, 1.78; 95% confidence interval, 1.27 to 2.49). In stratified analyses, the higher risk of graft loss among patients with cPRA ≥98% was only observed among repeat, but not first, transplant recipients. In subgroup analysis, there was no association between cPRA and graft loss among living related transplant recipients. CONCLUSIONS Calculated panel reactive antibody is poorly associated with post-transplant immune reactivity to the allograft in the absence of donor-specific antibody. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_01_25_CJN13640820_final.mp3.
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Affiliation(s)
- James H. Lan
- Vancouver Coastal Health Research Institute, Vancouver, Canada,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada,Division of Nephrology, Kidney Transplant Program, University of British Columbia, Vancouver, Canada
| | - Matthew Kadatz
- Vancouver Coastal Health Research Institute, Vancouver, Canada,Division of Nephrology, Kidney Transplant Program, University of British Columbia, Vancouver, Canada
| | | | - Jagbir Gill
- Division of Nephrology, Kidney Transplant Program, University of British Columbia, Vancouver, Canada,Providence Health Research Institute, Vancouver, Canada,Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - John S. Gill
- Division of Nephrology, Kidney Transplant Program, University of British Columbia, Vancouver, Canada,Providence Health Research Institute, Vancouver, Canada,Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts
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23
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Sullivan HC, Krummey SM, Gebel HM, Bray RA. The utility of second single antigen bead assay: Clearing the water or stirring up mud? Hum Immunol 2020; 81:663-670. [PMID: 33036787 PMCID: PMC8336427 DOI: 10.1016/j.humimm.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/25/2020] [Accepted: 09/24/2020] [Indexed: 12/01/2022]
Abstract
Though solid-phase single antigen bead (SAB) testing has provided major advances to the HLA community and organ allocation, it has not been without limitations. In particular, false-positive reactions lead to interpretative challenges and the potential to preclude a transplant if the corresponding antigens are deemed unacceptable. Two different vendor platforms are commercially available for SAB testing, one more recent than the other. The aim herein was to assess the benefit of using the newer SAB platform in situations where the primary platform yielded suspicious (specifically, false positive) reactions. Therefore, 42 serum samples with commonly encountered false-positive patterns observed in our laboratory were tested with the newer platform. Cases were classified as resolved, equivalent, or divergent based on whether the second platform produced no reactivity, the same pattern, or a distinctly different pattern compared to the primary platform, respectively. Approximately 33% of cases were resolved, 46% were equivalent, and 21% were divergent. The project revealed advantages of adding a second SAB platform to the laboratory's test menu including resolving challenging samples and including broader coverage of different alleles and unique class II alpha/beta subunit combinations. However, the challenges of validating, maintaining, and billing for another test method in the laboratory may be barriers to routine use.
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Affiliation(s)
- Harold C Sullivan
- Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA.
| | - Scott M Krummey
- Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
| | - Howard M Gebel
- Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
| | - Robert A Bray
- Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
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24
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Adam BA, Gebel HM. IgE in Antibody-Mediated Rejection: A Novel Pathogenic Mechanism? Clin J Am Soc Nephrol 2020; 15:1392-1393. [PMID: 33028604 PMCID: PMC7536743 DOI: 10.2215/cjn.13000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Benjamin A Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Howard M Gebel
- Department of Pathology, Emory University, Atlanta, Georgia
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25
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Sullivan HC, Gragert L, Smith GH, Lindblad K, Gebel HM, Bray RA. A simple electronic tool for assessing amino acid sequence polymorphisms within exon-2 of HLA-DPB1 alleles. Hum Immunol 2020; 81:430-436. [PMID: 32684412 DOI: 10.1016/j.humimm.2020.06.011] [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: 05/11/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
In November 2014, the OPTN/UNOS Board of Directors mandated that HLA-DPB1 typing be performed for all deceased donors. Currently, there are over 1,000 known HLA DPB1 alleles, yet fewer than 30 are represented on commonly used single antigen bead (SAB) solid phase antibody assays. Moreover, the official World Health Organization (WHO) nomenclature for the DPB1 locus does not permit assessment of structural relationships between alleles based on their names. Thus, for donor DPB1 alleles lacking a corresponding SAB, determining the compatibility between a donor-recipient pair when the recipient possesses DPB1 antibodies currently requires the use of manual sequence alignments. Multiple studies have reported that DPB1 alleles can be classified into serological-defined categories based on shared protein sequence motifs residing in distinct hypervariable regions. To date, six such motifs have been recognized. To address this problem, we developed a computer-assisted tool to compare donor and recipient DPB1 allele sequences, specifically those defined by DPB1 hypervariable region motifs located in exon 2 (http://dpreport.hlatools.org). This tool quickly identifies mismatched DPB1 motifs, and easily permits the identification of motif-based donor-specific antibodies (DSA) to DPB1.
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Affiliation(s)
- H Clifford Sullivan
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Loren Gragert
- Department of Pathology & Laboratory Medicine, Tulane University School of Medicine, New Orleans, LA, United States
| | | | - Kelsi Lindblad
- United Network for Organ Sharing, Richmond, VA, United States
| | - Howard M Gebel
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Robert A Bray
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States.
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Clifford Sullivan H, Krummey SM, Gebel HM, Bray RA, Jackson AM. Physical Crossmatching vs Virtual Crossmatching: The end of an era? or Why give up a good thing? Hum Immunol 2020; 81:401-406. [PMID: 32684410 DOI: 10.1016/j.humimm.2020.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- H Clifford Sullivan
- Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA.
| | - Scott M Krummey
- Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
| | - Howard M Gebel
- Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
| | - Robert A Bray
- Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
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Parsons RF, Zahid A, Bumb S, Decker H, Sullivan HC, Lee FEH, Badell IR, Ford ML, Larsen CP, Pearson TC, Jackson AM, Chen DF, Levine M, Kamoun M, Bray RA, Gebel HM. The impact of belatacept on third-party HLA alloantibodies in highly sensitized kidney transplant recipients. Am J Transplant 2020; 20:573-581. [PMID: 31452332 PMCID: PMC6984982 DOI: 10.1111/ajt.15585] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 02/12/2019] [Revised: 08/08/2019] [Accepted: 08/18/2019] [Indexed: 01/25/2023]
Abstract
Recent evidence suggests that belatacept reduces the durability of preexisting antibodies to class I and class II human leukocyte antigens (HLAs). In this case series of 163 highly sensitized kidney transplant candidates whose calculated panel-reactive antibody (cPRA) activity was ≥98% to 100%, the impact of belatacept on preexisting HLA antibodies was assessed. Of the 163 candidates, 72 underwent transplantation between December 4, 2014 and April 15, 2017; 60 of these transplanted patients remained on belatacept consecutively for at least 6 months. We observed a decrease in the breadth and/or strength of HLA class I antibodies as assessed by FlowPRA in belatacept-treated patients compared to controls who did not receive belatacept. Specifically, significant HLA antibody reduction was evident for class I (P < .0009). Posttransplant belatacept-treated patients also had a clinically significant reduction in their cPRA compared to controls (P < .01). Collectively, these findings suggest belatacept can reduce HLA class I antibodies in a significant proportion of highly sensitized recipients and could be an option to improve pretransplant compatibility with organ donors.
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Affiliation(s)
- Ronald F. Parsons
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Arslan Zahid
- Emory University School of Medicine, Atlanta, GA
| | - Shalini Bumb
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | | | | | - F. Eun-Hyung Lee
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - I. Raul Badell
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Mandy L. Ford
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Christian P. Larsen
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Thomas C. Pearson
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | | | - Dong-Feng Chen
- Department of Pathology, Duke University School of Medicine, Durham, NC
| | - Matthew Levine
- Division of Transplantation, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Malek Kamoun
- Department of Pathology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Robert A. Bray
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Howard M. Gebel
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
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Dean CL, Krummey SM, Gebel HM, Bray RA, Sullivan HC. Identification of a recurrent pattern of false-positivity by Luminex HLA MHC class I single antigen bead testing. Hum Immunol 2020; 81:73-78. [PMID: 31917024 DOI: 10.1016/j.humimm.2019.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/11/2019] [Revised: 12/12/2019] [Accepted: 12/26/2019] [Indexed: 02/07/2023]
Abstract
Previously, a distinct MHC class II Luminex-single antigen bead (SAB) pattern was described and attributed to antibodies targeting denatured antigens. In this study, we describe a distinct MHC class I reactivity pattern observed in 1.8% (105/5992) of samples resulted in 2017. The pattern displays reactivity to the following Luminex-SABs: HLA-A*33:03, A*36:01, A*80:01, B*54:01, B*53:01, C*06:02, C*07:02, C*18:02, C*14:02, C*03:03, C*03:04, and C*15:02. This pattern was identified in patients with no sensitization history, negative FlowPRA results, and antibody to self-antigen(s). Epitope analysis failed to reveal a common determinant(s) to explain this pattern of reactivity. Additionally, we found this pattern to be prevalent in female patients (62%) and also those with systemic lupus erythematosus (62%). Given these findings, we speculate this pattern likely represents false-positive reactivity, possibly due to antibody targeting denatured antigens or a specific peptide, molecular mimicry, autoimmunity, or a combination thereof.
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Affiliation(s)
- Christina L Dean
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
| | - Scott M Krummey
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
| | - Howard M Gebel
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
| | - Robert A Bray
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
| | - Harold C Sullivan
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States.
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Sapir-Pichhadze R, Zhang X, Ferradji A, Madbouly A, Tinckam KJ, Gebel HM, Blum D, Marrari M, Kim SJ, Fingerson S, Bashyal P, Cardinal H, Foster BJ. Epitopes as characterized by antibody-verified eplet mismatches determine risk of kidney transplant loss. Kidney Int 2019; 97:778-785. [PMID: 32059998 DOI: 10.1016/j.kint.2019.10.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 07/01/2019] [Revised: 09/26/2019] [Accepted: 10/17/2019] [Indexed: 01/01/2023]
Abstract
To optimize strategies that mitigate the risk of graft loss associated with HLA incompatibility, we evaluated whether sequence defined HLA targets (eplets) that result in donor-specific antibodies are associated with transplant outcomes. To define this, we fit multivariable Cox proportional hazard models in a cohort of 118 382 United States first kidney transplant recipients to assess risk of death-censored graft failure by increments of ten antibody-verified eplet mismatches. To verify robustness of our findings, we conducted sensitivity analysis in this United States cohort and assessed the role of antibody-verified eplet mismatches as autonomous predictors of transplant glomerulopathy in an independent Canadian cohort. Antibody-verified eplet mismatches were found to be independent predictors of death-censored graft failure with hazard ratios of 1.231 [95% confidence interval 1.195, 1. 268], 1.268 [1.231, 1.305] and 1.411 [1.331, 1.495] for Class I (HLA-A, B, and C), -DRB1 and -DQB1 loci, respectively. To address linkage disequilibrium between HLA-DRB1 and -DQB1, we fit models in a subcohort without HLA-DQB1 eplet mismatches and found hazard ratios for death-censored graft failure of 1.384 [1.293, 1.480] for each additional antibody-verified HLA-DRB1 eplet mismatch. In a subcohort without HLA-DRB1 mismatches, the hazard ratio was 1.384 [1.072, 1.791] for each additional HLA-DQB1 mismatch. In the Canadian cohort, antibody-verified eplet mismatches were independent predictors of transplant glomerulopathy with hazard ratios of 5.511 [1.442, 21.080] for HLA-DRB1 and 3.640 [1.574, 8.416] for -DRB1/3/4/5. Thus, donor-recipient matching for specific HLA eplets appears to be a feasible and clinically justifiable strategy to mitigate risk of graft loss.
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Affiliation(s)
- Ruth Sapir-Pichhadze
- Division of Nephrology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada; The Multi Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montreal, Quebec, Canada
| | - Abdelhakim Ferradji
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Abeer Madbouly
- Bioinformatics Research, Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota, USA
| | - Kathryn J Tinckam
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; The Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Howard M Gebel
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Daniel Blum
- Division of Nephrology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marilyn Marrari
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - S Joseph Kim
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; The Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Fingerson
- Bioinformatics Research, Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota, USA
| | - Pradeep Bashyal
- Bioinformatics Research, Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota, USA
| | | | - Bethany J Foster
- Centre for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Morris AB, Sullivan HC, Krummey SM, Gebel HM, Bray RA. Out with the old, in with the new: Virtual versus physical crossmatching in the modern era. HLA 2019; 94:471-481. [PMID: 31515937 DOI: 10.1111/tan.13693] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 07/09/2019] [Revised: 08/26/2019] [Accepted: 09/10/2019] [Indexed: 12/15/2022]
Abstract
The virtual crossmatch (VXM) is gaining acceptance as an alternative approach to assess donor:recipient compatibility prior to transplantation. In contrast to a physical crossmatch, the virtual crossmatch does not require viable donor cells but rather relies on complete HLA typing of the donor and current antibody assessment of the recipient. Thus, the VXM can be performed in minutes which allows for faster transplant decisions thereby increasing the likelihood that organs can be shipped across significant distances yet safely transplanted. Here, we present a brief review of the past 50 years of histocompatibility testing; from the original complement-dependent cytotoxicity crossmatch in 1969 to the new era of molecular HLA typing, solid-phase antibody testing and virtual crossmatching. These advancements have shaped a paradigm shift in our approach to transplantation. That is, foregoing a prospective physical crossmatch in favor of a VXM. In this review, we undertake an in-depth analysis of the pros- and cons- of physical and virtual crossmatching.Finally, we provide objective data on the selected use of the VXM which demonstrate the value of a VXM in lieu of the traditional physical crossmatch for safe and efficient organ transplantation.
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Affiliation(s)
- Anna B Morris
- Department of Surgery, Emory University, Atlanta, Georgia
| | - H C Sullivan
- Department of Pathology, Emory University, Atlanta, Georgia
| | | | - Howard M Gebel
- Department of Pathology, Emory University, Atlanta, Georgia
| | - Robert A Bray
- Department of Pathology, Emory University, Atlanta, Georgia
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McRacken T, Stephens M, Fortes W, Loescher J, Phelps E, Erica S, Gebel HM, Bray RA. P079 The great divide(R): Evidence for removing the MFI divider on the flexmap 3D. Hum Immunol 2019. [DOI: 10.1016/j.humimm.2019.07.132] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sullivan HC, Krummey SC, Wilmoth-Hosey, Lisa LC, Toddings R, Gebel HM, Bray RA. P081 Diagnostic management team: A virtual crossmatch consult. Hum Immunol 2019. [DOI: 10.1016/j.humimm.2019.07.134] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dean CL, Krummey S, Gebel HM, Bray RA, Sullivan HC. P176 A novel reactivity pattern with labscreen™ class II single antigen beads. Hum Immunol 2019. [DOI: 10.1016/j.humimm.2019.07.229] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Farris AB, Ellis CL, Rogers TE, Sullivan HC, Gebel HM, Bray RA, Hogan J, Vasanth P. P200 Renal allograft chronic active inflammation/rejection: analysis of banff ti and i-IFTA lesions in a contemporary biopsy cohort. Hum Immunol 2019. [DOI: 10.1016/j.humimm.2019.07.253] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Greenshields A, Bray RA, Gebel HM, Liwski RS. Getting on target: Development of the novel, prozone-resistant, dual antibody rapid test (DART) for the LABScreen single antigen bead (SAB) assay. Hum Immunol 2019; 80:468-477. [DOI: 10.1016/j.humimm.2019.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/20/2019] [Accepted: 04/25/2019] [Indexed: 12/22/2022]
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Feng S, Bucuvalas JC, Demetris AJ, Burrell BE, Spain KM, Kanaparthi S, Magee JC, Ikle D, Lesniak A, Lozano JJ, Alonso EM, Bray RA, Bridges NE, Doo E, Gebel HM, Gupta NA, Himes RW, Jackson AM, Lobritto SJ, Mazariegos GV, Ng VL, Rand EB, Sherker AH, Sundaram S, Turmelle YP, Sanchez-Fueyo A. Evidence of Chronic Allograft Injury in Liver Biopsies From Long-term Pediatric Recipients of Liver Transplants. Gastroenterology 2018; 155:1838-1851.e7. [PMID: 30144432 PMCID: PMC6279538 DOI: 10.1053/j.gastro.2018.08.023] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 07/26/2018] [Accepted: 08/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS A substantial proportion of pediatric liver transplant recipients develop subclinical chronic allograft injury. We studied whether there are distinct patterns of injury based on histopathologic features and identified associated immunologic profiles. METHODS We conducted a cross-sectional study of 157 stable, long-term pediatric recipients of transplanted livers (70 boys; > 6 years old at time of transplantation; mean, 8.9 ± 3.46 years after liver transplantation) who underwent liver biopsy analysis from August 13, 2012, through May 1, 2014. Participants had received livers from a living or deceased donor and had consistently normal results from liver tests. Liver biopsy specimens were scored by a central pathologist; an unsupervised hierarchical cluster analysis of histologic features was used to sort biopsy samples into 3 clusters. We conducted transcriptional and cytometric analyses of liver tissue samples and performed a systems biology analysis that incorporated clinical, serologic, histologic, and transcriptional data. RESULTS The mean level of alanine aminotransferase in participants was 27.6 ± 14.57 U/L, and the mean level of γ-glutamyl transferase was 17.4 ± 7.93 U/L. Cluster 1 was characterized by interface activity (n = 34), cluster 2 was characterized by periportal or perivenular fibrosis without interface activity (n = 45), and cluster 3 had neither feature (n = 78). We identified a module of genes whose expression correlated with levels of alanine aminotransferase, class II donor-specific antibody, portal inflammation, interface activity, perivenular inflammation, portal and perivenular fibrosis, and cluster assignment. The module was enriched in genes that regulate T-cell-mediated rejection (TCMR) of liver and other transplanted organs. Functional pathway analysis showed overrepresentation of TCMR gene sets for cluster 1 but not clusters 2 or 3. CONCLUSION In an analysis of biopsies from an apparently homogeneous group of stable, long-term pediatric liver transplant recipients with consistently normal liver test results, we found evidence of chronic graft injury (inflammation and/or fibrosis). Biopsy samples with interface activity had a gene expression pattern associated with TCMR.
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Affiliation(s)
- Sandy Feng
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, California.
| | - John C. Bucuvalas
- Pediatric Liver Care Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | | | | | | | - John C. Magee
- Section of Transplant Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Andrew Lesniak
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Juan J. Lozano
- Biomedical Research Center in Hepatic and Digestive Diseases, Carlos III Health Institute, Barcelona, Spain
| | - Estella M. Alonso
- Siragusa Transplantation Center, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Robert A. Bray
- Department of Pathology, Emory University Hospital, Atlanta, GA
| | - Nancy E. Bridges
- Transplantation Branch; Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, Rockville, MD
| | - Edward Doo
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD; Department of Pathology, Emory University Hospital, Atlanta, GA
| | - Howard M. Gebel
- Department of Pathology, Emory University Hospital, Atlanta, GA
| | - Nitika A. Gupta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Ryan W. Himes
- Section of Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, TX
| | - Annette M. Jackson
- Division of Immunogenetics and Transplantation Immunology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Steven J. Lobritto
- Center for Liver Diseases and Transplantation, Department of Surgery, Columbia University Medical Center, New York, NY
| | - George V. Mazariegos
- Hillman Center for Pediatric Transplantation, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Vicky L. Ng
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Center, Toronto, Ontario, Canada
| | - Elizabeth B. Rand
- Liver Transplant Program, The Children’s Hospital of Pennsylvania, Philadelphia, PA
| | - Averell H. Sherker
- Siragusa Transplantation Center, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Shikha Sundaram
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Yumirle P. Turmelle
- Division of Gastroenterology, Hepatology, and Nutrition, St. Louis Children’s Hospital, St. Louis, MO
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Parsons R, Decker H, Patzer R, Bumb S, Sullivan HC, Bray RA, Gebel HM. OR11 Characteristics of transplant candidates with cPRA ⩾ 99.95% likely to be allocated organs from deceased donors. Hum Immunol 2018. [DOI: 10.1016/j.humimm.2018.07.016] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Dean CL, Bray RA, Gebel HM, Sullivan HC. OR8 A novel reactivity pattern with labscreen™ class I single antigen beads and its prevalence among SLE patients. Hum Immunol 2018. [DOI: 10.1016/j.humimm.2018.07.013] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jacob RP, Dean CL, Krummey SM, Goodman AL, Roback JD, Gebel HM, Bray RA, Sullivan HC. Stability of anti-A blood group titers among blood group B renal transplant candidates. Transfusion 2018; 58:2747-2751. [PMID: 30265763 DOI: 10.1111/trf.14923] [Citation(s) in RCA: 3] [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: 04/20/2018] [Revised: 07/07/2018] [Accepted: 07/11/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND As deceased donor kidney allocation is based in part on blood type compatibility, group B candidates are disadvantaged due to their disproportionate representation on the wait list compared to the group B donor pool. To mitigate this discrepancy, group B candidates can receive group A2 or A2 B donor kidneys if their anti-A titers are below a predetermined cutoff. Currently, eligibility is reverified quarterly to UNet based on individual center protocols, which can vary due to a lack of set guidelines for monitoring ABO titers in these patients. Our goal was to assess the stability of anti-A titers in blood group B renal transplant candidates over time to provide data that could aid in the development of standardized ABO titer protocols. STUDY DESIGN AND METHODS Titers performed between January 2011 and December 2015 were assessed for 191 group B patients with two or more documented titers. RESULTS Fifty patients (26%) were ineligible, as the first titer exceeded the cutoff of 8. Of the remaining 141 patients, 19 (13%) became ineligible as the second titer exceeded 8. Thirty-nine patients (28%) had no change in titer between samples, while 71 (50%) had a titer change that never exceeded 8. Only 12 patients (8.5% of total) experienced a titer change that affected eligibility after the second test. CONCLUSION Although patients experience some variability in anti-A titers over time, in most cases, stability did not affect candidate eligibility. Our results indicate that regular testing beyond the second titer may be unnecessary and represent test overutilization.
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Affiliation(s)
- Reuben P Jacob
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Christina L Dean
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Scott M Krummey
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Abigail L Goodman
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - John D Roback
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Howard M Gebel
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Robert A Bray
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Harold C Sullivan
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
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Affiliation(s)
- Jenna Wade
- Emory University School of Medicine, Atlanta, GA
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41
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Everly MJ, Roberts M, Townsend R, Bray RA, Gebel HM. Comparison of de novo IgM and IgG anti-HLA DSAs between belatacept- and calcineurin-treated patients: An analysis of the BENEFIT and BENEFIT-EXT trial cohorts. Am J Transplant 2018; 18:2305-2313. [PMID: 29767445 DOI: 10.1111/ajt.14939] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 12/24/2017] [Revised: 04/30/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023]
Abstract
Preventing conversion of donor-specific anti-HLA antibodies (DSAs) from an IgM-to-IgG could a way to prevent chronic rejection. We evaluated whether belatacept-treated patients (belatacept less-intensive [LI] or more-intensive [MI] regimens) have a lower rate of conversion than do cyclosporine A (CsA)-treated patients. We included 330 HLA-mismatched patients from 2 phase 3 trials with either (a) complete donor/recipient HLA-A, -B, -DR, and -DQ loci typing or (b) incomplete HLA typing with IgG DSAs detected pretransplant or posttransplant. IgM and IgG DSAs were tested with single antigen beads at 0, 6, 12, 24, and 36 months posttransplant. The overall (preexisting or de novo) rates of IgM- and IgG-positive DSAs were 29% and 34%, respectively. The pretransplant IgM and IgG DSA-positive frequencies were similar between treatment groups. The IgG-positive dnDSA rate was significantly higher in the CsA-treated group (34%) compared with the belatacept-LI (8%) and belatacept-MI (11%) (P < .001) groups. In IgM-positive dnDSA patients, the IgG-positive dnDSA rate of conversion was 2.8 times higher in the CsA group than in the combined belatacept groups (P = .006). However, the observed association between belatacept treatment and more limited conversion of IgM-to-IgG dnDSAs was based on a limited number of patients and requires further validation.
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Affiliation(s)
| | - Mustimbo Roberts
- Immunology Biomarker Group, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Robert Townsend
- Immunology Biomarker Group, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Robert A Bray
- Emory University School of Medicine, Pathology& Laboratory Medicine, Atlanta, GA, USA
| | - Howard M Gebel
- Emory University School of Medicine, Pathology& Laboratory Medicine, Atlanta, GA, USA
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Sullivan HC, Dean CL, Liwski RS, Biswas S, Goodman AL, Krummey S, Gebel HM, Bray RA. (F)Utility of the physical crossmatch for living donor evaluations in the age of the virtual crossmatch. Hum Immunol 2018; 79:711-715. [PMID: 30081064 DOI: 10.1016/j.humimm.2018.08.001] [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: 04/29/2018] [Revised: 07/23/2018] [Accepted: 08/02/2018] [Indexed: 12/12/2022]
Abstract
Flow cytometric crossmatches (FCXM) are routinely performed to support living-donor renal transplantation. While long a laboratory mainstay, a physical crossmatch is costly, time consuming, and frequently poses interpretative conundrums with both false-positive and false- negative results. Given the increased utilization of the virtual crossmatch (vXM) in the deceased donor setting, our aim was to assess its utility in living donor evaluations. We reviewed 100 living donor FCXMs and retrospectively performed a vXM for each pair. Seventy-five (75) cases were concordant, (i.e., FCXM-/vXM- or FCXM+/vXM+) while 25 cases were discordant; Five were vXM+/FCXM- and 20 were FCXM+/vXM-. Since donor-specific antibodies (DSA) were not detected in the 20 FCXM+/vXM- cases, these were interpreted as false-positive, i.e., due to non-HLA antibodies. Importantly, none of these patients, when transplanted across a positive FCXM, experienced early antibody mediated rejection or subsequently developed HLA DSA. These data reveal that, for the vast majority of living donor evaluations, a vXM is an acceptable vetting procedure.
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Affiliation(s)
- Harold C Sullivan
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA.
| | - Christina L Dean
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Robert S Liwski
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shilpee Biswas
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Abigail L Goodman
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Scott Krummey
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Howard M Gebel
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Robert A Bray
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
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Tambur AR, Campbell P, Claas FH, Feng S, Gebel HM, Jackson AM, Mannon RB, Reed EF, Tinckam K, Askar M, Chandraker A, Chang PP, Colvin M, Demetris AJ, Diamond JM, Dipchand AI, Fairchild RL, Ford ML, Friedewald J, Gill RG, Glotz D, Goldberg H, Hachem R, Knechtle S, Kobashigawa J, Levine DJ, Levitsky J, Mengel M, Milford E, Newell KA, O'Leary JG, Palmer S, Randhawa P, Smith J, Snyder L, Starling RC, Sweet S, Taner T, Taylor CJ, Woodle S, Zeevi A, Nickerson P. Sensitization in Transplantation: Assessment of Risk (STAR) 2017 Working Group Meeting Report. Am J Transplant 2018; 18:1604-1614. [PMID: 29603613 DOI: 10.1111/ajt.14752] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [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: 01/05/2018] [Revised: 02/25/2018] [Accepted: 03/20/2018] [Indexed: 02/06/2023]
Abstract
The presence of preexisting (memory) or de novo donor-specific HLA antibodies (DSAs) is a known barrier to successful long-term organ transplantation. Yet, despite the fact that laboratory tools and our understanding of histocompatibility have advanced significantly in recent years, the criteria to define presence of a DSA and assign a level of risk for a given DSA vary markedly between centers. A collaborative effort between the American Society for Histocompatibility and Immunogenetics and the American Society of Transplantation provided the logistical support for generating a dedicated multidisciplinary working group, which included experts in histocompatibility as well as kidney, liver, heart, and lung transplantation. The goals were to perform a critical review of biologically driven, state-of-the-art, clinical diagnostics literature and to provide clinical practice recommendations based on expert assessment of quality and strength of evidence. The results of the Sensitization in Transplantation: Assessment of Risk (STAR) meeting are summarized here, providing recommendations on the definition and utilization of HLA diagnostic testing, and a framework for clinical assessment of risk for a memory or a primary alloimmune response. The definitions, recommendations, risk framework, and highlighted gaps in knowledge are intended to spur research that will inform the next STAR Working Group meeting in 2019.
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Affiliation(s)
| | | | - Frans H Claas
- Leiden University Medical Center, Leiden, Netherlands
| | - Sandy Feng
- UCSF Medical Center, San Francisco, California
| | | | | | | | - Elaine F Reed
- UCLA Pathology & Laboratory Medicine, Los Angeles, California
| | | | | | | | | | | | | | | | | | | | - Mandy L Ford
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Ramsey Hachem
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | | | | | - Edgar Milford
- Brigham and Women's' Hospital, Boston, Massachusetts
| | | | | | - Scott Palmer
- Duke University School of Medicine, Durham, North Carolina
| | | | - John Smith
- Royal Brompton & Harefield NHS Foundation Trust, Harefield, UK
| | - Laurie Snyder
- Duke University School of Medicine, Durham, North Carolina
| | | | - Stuart Sweet
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | - Adriana Zeevi
- University of Pittsburg Medical Center, Pittsburgh, Pennsylvania
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Cole RT, Gandhi J, Bray RA, Gebel HM, Yin M, Shekiladze N, Young A, Grant A, Mahoney I, Laskar SR, Gupta D, Bhatt K, Book W, Smith A, Nguyen D, Vega JD, Morris AA. Racial differences in the development of de-novo donor-specific antibodies and treated antibody-mediated rejection after heart transplantation. J Heart Lung Transplant 2018; 37:503-512. [DOI: 10.1016/j.healun.2017.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022] Open
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45
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Sullivan HC, Dean CL, Goodman AL, Bray RA, Gebel HM. P153 Utility of the virtual crossmatch for living donor evaluations. Hum Immunol 2017. [DOI: 10.1016/j.humimm.2017.06.213] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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46
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Sullivan HC, Dean CL, Krummey SM, Jacob RP, Goodman AL, Gebel HM, Bray RA. P047 Stability of anti-A2 blood group subtype titers among blood group B candidates. Hum Immunol 2017. [DOI: 10.1016/j.humimm.2017.06.107] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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47
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Ingemi A, McRacken T, Herre J, Bray RA, Gebel HM. P057 Factors THA impact downregulation of HLA antibodies in heart transplant candidates. Hum Immunol 2017. [DOI: 10.1016/j.humimm.2017.06.117] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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48
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Waslaske SH, McPherson EM, Gebel HM, Bray RA. P015 Removal of selected non-specific reactivity in single antigen bead assays via FBS pre-treatment. Hum Immunol 2017. [DOI: 10.1016/j.humimm.2017.06.075] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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49
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Greenshields AL, Bray RA, Gebel HM, Liwski RS. P023 Getting on target: Development of the novel, prozone-resistant, dual antibody rapid test (DART) for the labscreen single antigen bead (SAB) assay. Hum Immunol 2017. [DOI: 10.1016/j.humimm.2017.06.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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50
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Liwski RS, Greenshields AL, Murphey C, Bray RA, Gebel HM. It’s about time: The development and validation of a rapid optimized single antigen bead (ROB) assay protocol for LABScreen. Hum Immunol 2017; 78:489-499. [DOI: 10.1016/j.humimm.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/27/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
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