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Lehmann C, Pehnke S, Weimann A, Bachmann A, Dittrich K, Petzold F, Fürst D, de Fallois J, Landgraf R, Henschler R, Lindner TH, Halbritter J, Doxiadis I, Popp B, Münch J. Extended genomic HLA typing identifies previously unrecognized mismatches in living kidney transplantation. Front Immunol 2023; 14:1094862. [PMID: 36776892 PMCID: PMC9911689 DOI: 10.3389/fimmu.2023.1094862] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/10/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023] Open
Abstract
Introduction Antibody mediated rejection (ABMR) is the most common cause of long-term allograft loss in kidney transplantation (KT). Therefore, a low human leukocyte antigen (HLA) mismatch (MM) load is favorable for KT outcomes. Hitherto, serological or low-resolution molecular HLA typing have been adapted in parallel. Here, we aimed to identify previously missed HLA mismatches and corresponding antibodies by high resolution HLA genotyping in a living-donor KT cohort. Methods 103 donor/recipient pairs transplanted at the University of Leipzig Medical Center between 1998 and 2018 were re-typed using next generation sequencing (NGS) of the HLA loci -A, -B, -C, -DRB1, -DRB345, -DQA1, -DQB1, -DPA1, and -DPB1. Based on these data, we compiled HLA MM counts for each pair and comparatively evaluated genomic HLA-typing with pre-transplant obtained serological/low-resolution HLA (=one-field) typing results. NGS HLA typing (=two-field) data was further used for reclassification of de novo HLA antibodies as "donor-specific". Results By two-field HLA re-typing, we were able to identify additional MM in 64.1% (n=66) of cases for HLA loci -A, -B, -C, -DRB1 and -DQB1 that were not observed by one-field HLA typing. In patients with biopsy proven ABMR, two-field calculated MM count was significantly higher than by one-field HLA typing. For additional typed HLA loci -DRB345, -DQA1, -DPA1, and -DPB1 we observed 2, 26, 3, and 23 MM, respectively. In total, 37.3% (69/185) of de novo donor specific antibodies (DSA) formation was directed against these loci (DRB345 ➔ n=33, DQA1 ➔ n=33, DPA1 ➔ n=1, DPB1 ➔ n=10). Conclusion Our results indicate that two-field HLA typing is feasible and provides significantly more sensitive HLA MM recognition in living-donor KT. Furthermore, accurate HLA typing plays an important role in graft management as it can improve discrimination between donor and non-donor HLA directed cellular and humoral alloreactivity in the long range. The inclusion of additional HLA loci against which antibodies can be readily detected, HLA-DRB345, -DQA1, -DQB1, -DPA1, and -DPB1, will allow a more precise virtual crossmatch and better prediction of potential DSA. Furthermore, in living KT, two-field HLA typing could contribute to the selection of the immunologically most suitable donors.
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Affiliation(s)
- Claudia Lehmann
- Institute for Transfusion Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Sarah Pehnke
- Division of Nephrology, Department of Internal Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Antje Weimann
- Division of Visceral Surgery and Transplantation Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Anette Bachmann
- Division of Nephrology, Department of Internal Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Katalin Dittrich
- Department of Pediatric Nephrology, University of Leipzig Medical Center, Leipzig, Germany
| | - Friederike Petzold
- Division of Nephrology, Department of Internal Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Daniel Fürst
- Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Jonathan de Fallois
- Division of Nephrology, Department of Internal Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Ramona Landgraf
- Institute for Transfusion Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Reinhard Henschler
- Institute for Transfusion Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Tom H Lindner
- Division of Nephrology, Department of Internal Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Jan Halbritter
- Division of Nephrology, Department of Internal Medicine, University of Leipzig Medical Center, Leipzig, Germany.,Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ilias Doxiadis
- Institute for Transfusion Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Bernt Popp
- Institute of Human Genetics, University of Leipzig, Leipzig, Germany
| | - Johannes Münch
- Division of Nephrology, Department of Internal Medicine, University of Leipzig Medical Center, Leipzig, Germany.,Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
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Walter Costa MB, Wernsdorfer M, Kehrer A, Voigt M, Cundius C, Federbusch M, Eckelt F, Remmler J, Schmidt M, Pehnke S, Gärtner C, Wehner M, Isermann B, Richter H, Telle J, Kaiser T. The Clinical Decision Support System AMPEL for Laboratory Diagnostics: Implementation and Technical Evaluation. JMIR Med Inform 2021; 9:e20407. [PMID: 34081013 PMCID: PMC8212627 DOI: 10.2196/20407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/15/2020] [Revised: 08/28/2020] [Accepted: 11/20/2020] [Indexed: 12/21/2022] Open
Abstract
Background Laboratory results are of central importance for clinical decision making. The time span between availability and review of results by clinicians is crucial to patient care. Clinical decision support systems (CDSS) are computational tools that can identify critical values automatically and help decrease treatment delay. Objective With this work, we aimed to implement and evaluate a CDSS that supports health care professionals and improves patient safety. In addition to our experiences, we also describe its main components in a general manner to make it applicable to a wide range of medical institutions and to empower colleagues to implement a similar system in their facilities. Methods Technical requirements must be taken into account before implementing a CDSS that performs laboratory diagnostics (labCDSS). These can be planned within the functional components of a reactive software agent, a computational framework for such a CDSS. Results We present AMPEL (Analysis and Reporting System for the Improvement of Patient Safety through Real-Time Integration of Laboratory Findings), a labCDSS that notifies health care professionals if a life-threatening medical condition is detected. We developed and implemented AMPEL at a university hospital and regional hospitals in Germany (University of Leipzig Medical Center and the Muldental Clinics in Grimma and Wurzen). It currently runs 5 different algorithms in parallel: hypokalemia, hypercalcemia, hyponatremia, hyperlactatemia, and acute kidney injury. Conclusions AMPEL enables continuous surveillance of patients. The system is constantly being evaluated and extended and has the capacity for many more algorithms. We hope to encourage colleagues from other institutions to design and implement similar CDSS using the theory, specifications, and experiences described in this work.
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Affiliation(s)
- Maria Beatriz Walter Costa
- Institute of Laboratory Medicine, Clinical Chemistry und Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany.,Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Mark Wernsdorfer
- Institute of Laboratory Medicine, Clinical Chemistry und Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany.,Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Markus Voigt
- Information Management, University of Leipzig Medical Center, Leipzig, Germany
| | - Carina Cundius
- Information Management, University of Leipzig Medical Center, Leipzig, Germany
| | - Martin Federbusch
- Institute of Laboratory Medicine, Clinical Chemistry und Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
| | - Felix Eckelt
- Institute of Laboratory Medicine, Clinical Chemistry und Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
| | - Johannes Remmler
- Institute of Laboratory Medicine, Clinical Chemistry und Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
| | - Maria Schmidt
- Institute of Laboratory Medicine, Clinical Chemistry und Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany.,Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Sarah Pehnke
- Institute of Laboratory Medicine, Clinical Chemistry und Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
| | - Christiane Gärtner
- Institute of Laboratory Medicine, Clinical Chemistry und Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany.,Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Markus Wehner
- Muldental Clinics GmbH Non-Profit Company, Hospital Grimma and Wurzen, Grimma, Germany
| | - Berend Isermann
- Institute of Laboratory Medicine, Clinical Chemistry und Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
| | - Heike Richter
- Muldental Clinics GmbH Non-Profit Company, Hospital Grimma and Wurzen, Grimma, Germany
| | | | - Thorsten Kaiser
- Institute of Laboratory Medicine, Clinical Chemistry und Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
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Wolf J, Kaiser T, Pehnke S, Nickel O, Lübbert C, Kalbitz S, Arnold B, Ermisch J, Berger L, Schroth S, Isermann B, Borte S, Biemann R. Differences of SARS-CoV-2 serological test performance between hospitalized and outpatient COVID-19 cases. Clin Chim Acta 2020; 511:352-359. [PMID: 33159952 PMCID: PMC7642750 DOI: 10.1016/j.cca.2020.10.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Serological severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody assays differ in the target antigen specificity, e.g. of antibodies directed against the viral spike or the nucleocapsid protein, and in the spectrum of detected immunoglobulins. The aim of the study was to evaluate the performance of two different routinely used immunoassays in hospitalized and outpatient COVID-19 cases. METHODS The test characteristics of commercially available spike1 protein-based serological assays (Euroimmun, EI-assays), determining IgA or IgG and nucleocapsid-based assays (Virotech, VT-assays) determining IgA, IgM or IgG were compared in 139 controls and 116 hospitalized and outpatient COVID-19 cases. RESULTS Hospitalized COVID-19 patients (n = 51; 115 samples) showed significantly higher concentrations of antibodies against SARS-CoV-2 and differed from outpatient cases (n = 65) by higher age, higher disease severity scores and earlier follow up blood sampling. Sensitivity of the two IgG assays was comparable in hospitalized patients tested ≥ 14 days (EI-assay: 88%, CI95% 67.6-99.9; VT-assay: 96%, CI95% 77.7-99.8). In outpatient COVID-19 cases sensitivity was significantly lower in the VT-assay (86.2%, CI95% 74.8-93.1) compared with the EI-assay (98.5%, CI95% 90.6-99.9). Assays for IgA and IgM demonstrated a lack of specificity or sensitivity. CONCLUSIONS Our results indicate that SARS-CoV-2 serological assays may need to be optimized to produce reliable results in outpatient COVID-19 cases who are low or even asymptomatic. Assays for IgA and IgM have limited diagnostic performance and do not prove an additional value for population-based screening approaches.
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Affiliation(s)
- Johannes Wolf
- Department of Laboratory Medicine, Hospital St. Georg, Leipzig, Germany,ImmunoDeficiencyCenter Leipzig (IDCL) at Hospital St. Georg Leipzig, Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiency Diseases, Leipzig, Germany
| | - Thorsten Kaiser
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital, Leipzig, Germany
| | - Sarah Pehnke
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital, Leipzig, Germany
| | - Olaf Nickel
- Department of Laboratory Medicine, Hospital St. Georg, Leipzig, Germany
| | - Christoph Lübbert
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany,Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany,Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Hospital, Leipzig, Germany
| | - Sven Kalbitz
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
| | - Benjamin Arnold
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
| | - Jörg Ermisch
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
| | - Luisa Berger
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
| | - Stefanie Schroth
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
| | - Berend Isermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital, Leipzig, Germany
| | - Stephan Borte
- Department of Laboratory Medicine, Hospital St. Georg, Leipzig, Germany,ImmunoDeficiencyCenter Leipzig (IDCL) at Hospital St. Georg Leipzig, Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiency Diseases, Leipzig, Germany,Department of Laboratory Medicine, Division of Clinical Immunology, Karolinska Institute at Karolinska University Hospital, Huddinge, Sweden
| | - Ronald Biemann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital, Leipzig, Germany,Corresponding author at: Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital Leipzig, Paul List Straße 16-18, 04103 Leipzig, Germany
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Pehnke S, Lindner TH, Popp B, Doxiadis I, Landgraf R, Lehmann C, Halbritter J, Münch J. P1776HLA TYPING BY NGS ENHANCES MISMATCH DETECTION IN LIVING KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1776] [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: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Antibody mediated rejection (ABMR) due to the development of donor specific HLA antibodies is the most common cause for graft loss in kidney transplant recipients. Therefore, a low count of HLA mismatches is favorable in the course of transplantation. Hitherto, several techniques for HLA typing have been adapted in parallel, e.g. serological or low-resolution PCR. In this single-center study, we aimed to perform “HLA re-typing” by next generation sequencing (NGS) in a living kidney transplant cohort (n=143), in order to identify HLA mismatches in donor/recipient pairs, that were missed by previous HLA typing methods.
Method
We isolated DNA of 102 donor/recipient pairs, that received a living kidney transplantation at the University Hospital Leipzig (Germany) between 1998 and 2018, and performed long range PCR of all known HLA loci. Using these NGS results, we compiled a genomic HLA mismatch formula. We evaluated, if genomic HLA typing identifies more HLA mismatches compared to the results of previous HLA typing methods, that were recorded in the Eurotransplant database for our donor/recipient pairs.
Results
By genomic HLA typing, we were able to identify HLA mismatches in 10.2 % of donor/recipient pairs, that have been missed by previous methods. In our cohort, we recognized most mismatches in the DRB1 locus, that were missed with other HLA typing techniques.
Conclusion
Our results suggest, that genomic HLA typing can be more precise in detecting HLA mismatches in donor recipient/pairs. Especially in the course of living kidney transplantation, a higher accuracy in HLA typing might enhance donor selection. Furthermore, accurate HLA typing can influence graft management in the course of ABMR, as it may improve the detection of donor specific HLA directed antibodies.
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Affiliation(s)
- Sarah Pehnke
- University Hospital Leipzig, Division of Nephrology, Department of Internal Medicine, Leipzig, Germany
| | - Tom H Lindner
- University Hospital Leipzig, Division of Nephrology, Department of Internal Medicine, Leipzig, Germany
| | - Bernt Popp
- University Hospital Leipzig, Institute of Human Genetics, Leipzig, Germany
| | - Ilias Doxiadis
- University Hospital Leipzig, Institute for Transfusion Medicine, Leipzig, Germany
| | - Ramona Landgraf
- University Hospital Leipzig, Institute for Transfusion Medicine, Leipzig, Germany
| | - Claudia Lehmann
- University Hospital Leipzig, Institute for Transfusion Medicine, Leipzig, Germany
| | - Jan Halbritter
- University Hospital Leipzig, Division of Nephrology, Department of Internal Medicine, Leipzig, Germany
| | - Johannes Münch
- University Hospital Leipzig, Division of Nephrology, Department of Internal Medicine, Leipzig, Germany
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