Zecher, Daniel and Bach, Christian and Preiss, Adrian and Staudner, Christoph and Utpatel, Kirsten and Evert, Matthias and Jung, Bettina and Bergler, Tobias and Boeger, Carsten A. and Spriewald, Bernd M. and Banas, Bernhard (2018) Analysis of Luminex-based Algorithms to Define Unacceptable HLA Antibodies in CDC-crossmatch Negative Kidney Transplant Recipients. TRANSPLANTATION, 102 (6). pp. 969-977. ISSN 0041-1337, 1534-6080
Full text not available from this repository. (Request a copy)Abstract
Background. HLA-specific antibodies detected by solid phase assays are increasingly used to define unacceptable HLA antigen mismatches (UAM) before renal transplantation. The accuracy of this approach is unclear. Methods. Day of transplant sera from 211 complement-dependent cytotoxicity crossmatch-negative patients were retrospectively analyzed for donor-specific anti-HLA antibodies (DSA) using Luminex technology. HLA were defined as UAM if DSA had mean fluorescence intensity above (I) 3000 (patients retransplanted and those with DSA against HLA class I and II) or 5000 (all other patients), (H) 5000 for HLA-A, -B, and -DR and 10000 for HLA DQ or (III) 10000 (all HLA). We then studied the accuracy of these algorithms to identify patients with antibody-mediated rejection (AMR) and graft loss. UAM were also determined in 256 transplant candidates and vPRA levels calculated. Results. At transplantation, 67 of 211 patients had DSA. Of these, 31 (algorithm I), 24 (II) and 17 (III) had UAM. Nine (I and II) and 8 (III) of 11 early AMR episodes and 7 (I), 6 (II) and 5 (III) of 9 graft losses occurred in UAM-positive patients during 4.9 years of follow-up. Algorithms I and II identified patients with persistently lower glomerular filtration rate even in the absence of overt AMR. Of the waiting list patients, 22-33% had UAM with median virtual panel reactive antibody of 69.2% to 79.1%. Conclusions. Algorithms I and II had comparable efficacy but were superior to Algorithm HI in identifying at-risk patients at an acceptable false-positive rate. However, Luminex-defined UAM significantly restrict the donor pool of affected patients, which might prolong waiting time.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | HUMAN-LEUKOCYTE ANTIGENS; MEDIATED REJECTION; IMMUNOLOGICAL RISK; WAITING TIME; DESENSITIZATION; IMMUNOGLOBULIN; MISMATCHES; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Abteilung für Nephrologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 20 Feb 2020 08:19 |
| Last Modified: | 20 Feb 2020 08:19 |
| URI: | https://pred.uni-regensburg.de/id/eprint/14500 |
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