Clinical Relevance of Pretransplant Donor-Specific HLA Antibodies Detected by Single-Antigen Flow-Beads
Defining the clinical relevance of donor-specific HLA-antibodies detected by single-antigen flow-beads (SAFB) is important because these assays are increasingly used for pretransplant risk assessment and organ allocation. The aims of this study were to investigate to which extent HLA-DSA detected by...
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| Veröffentlicht in: | Transplantation 2009-06, Vol.87 (11), p.1681-1688 |
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| creator | AMICO, Patrizia HÖNGER, Gideon MAYR, Michael STEIGER, Jürg HOPFER, Helmut SCHAUB, Stefan |
| description | Defining the clinical relevance of donor-specific HLA-antibodies detected by single-antigen flow-beads (SAFB) is important because these assays are increasingly used for pretransplant risk assessment and organ allocation. The aims of this study were to investigate to which extent HLA-DSA detected by SAFB represent a risk for antibody-mediated rejection (AMR) and diminished allograft survival, and to define HLA-DSA characteristics predictive for AMR.
In this retrospective study of 334 patients with negative complement-dependent cytotoxicity crossmatches, day-of-transplant sera were analyzed by SAFB, HLA-DSA determined by virtual crossmatching, and the results correlated with the occurrence of AMR and allograft survival.
Sixty-seven of 334 patients (20%) had HLA-DSA. The incidence of clinical/subclinical AMR at day 200 posttransplant was significantly higher in patients with HLA-DSA than in patients without HLA-DSA (55% vs. 6%; P |
| doi_str_mv | 10.1097/tp.0b013e3181a5e034 |
| format | Article |
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In this retrospective study of 334 patients with negative complement-dependent cytotoxicity crossmatches, day-of-transplant sera were analyzed by SAFB, HLA-DSA determined by virtual crossmatching, and the results correlated with the occurrence of AMR and allograft survival.
Sixty-seven of 334 patients (20%) had HLA-DSA. The incidence of clinical/subclinical AMR at day 200 posttransplant was significantly higher in patients with HLA-DSA than in patients without HLA-DSA (55% vs. 6%; P<0.0001). Notably, 30/67 patients with HLA-DSA (45%) did not experience clinical/subclinical AMR. Death-censored 5-year allograft survival was equal in patient without HLA-DSA and patients with HLA-DSA but no AMR (89% vs. 87%; P=0.95), whereas it was 20% lower in patients with HLA-DSA and AMR (68%; P=0.002). The number, class, and cumulative strength of HLA-DSA determined by SAFB, and prior sensitizing events were not predictive for the occurrence of AMR.
These results support the utility of SAFB for pretransplant risk assessment and organ allocation, and suggest that improvement of the positive predictive value of HLA-DSA defined by SAFB will require an enhanced definition of pathogenic factors of HLA-DSA.</description><identifier>ISSN: 0041-1337</identifier><identifier>EISSN: 1534-6080</identifier><identifier>DOI: 10.1097/tp.0b013e3181a5e034</identifier><identifier>PMID: 19502960</identifier><identifier>CODEN: TRPLAU</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adolescent ; Adult ; Aged ; Biological and medical sciences ; Biopsy ; Cadaver ; Drug Therapy, Combination ; Female ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Graft Rejection - epidemiology ; Graft Rejection - pathology ; Histocompatibility Testing - methods ; HLA Antigens - immunology ; Humans ; Immunosuppressive Agents - therapeutic use ; Isoantibodies - blood ; Isoantibodies - immunology ; Kidney Transplantation - immunology ; Living Donors ; Male ; Medical sciences ; Middle Aged ; Preoperative Care ; Retrospective Studies ; Risk Assessment ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Tissue Donors - statistics & numerical data ; Tissue, organ and graft immunology ; Young Adult</subject><ispartof>Transplantation, 2009-06, Vol.87 (11), p.1681-1688</ispartof><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-2db74be16229602bff43dab698410fab5a7ecba0a876f954ad522137deb2f1d3</citedby><cites>FETCH-LOGICAL-c475t-2db74be16229602bff43dab698410fab5a7ecba0a876f954ad522137deb2f1d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21567810$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19502960$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>AMICO, Patrizia</creatorcontrib><creatorcontrib>HÖNGER, Gideon</creatorcontrib><creatorcontrib>MAYR, Michael</creatorcontrib><creatorcontrib>STEIGER, Jürg</creatorcontrib><creatorcontrib>HOPFER, Helmut</creatorcontrib><creatorcontrib>SCHAUB, Stefan</creatorcontrib><title>Clinical Relevance of Pretransplant Donor-Specific HLA Antibodies Detected by Single-Antigen Flow-Beads</title><title>Transplantation</title><addtitle>Transplantation</addtitle><description>Defining the clinical relevance of donor-specific HLA-antibodies detected by single-antigen flow-beads (SAFB) is important because these assays are increasingly used for pretransplant risk assessment and organ allocation. The aims of this study were to investigate to which extent HLA-DSA detected by SAFB represent a risk for antibody-mediated rejection (AMR) and diminished allograft survival, and to define HLA-DSA characteristics predictive for AMR.
In this retrospective study of 334 patients with negative complement-dependent cytotoxicity crossmatches, day-of-transplant sera were analyzed by SAFB, HLA-DSA determined by virtual crossmatching, and the results correlated with the occurrence of AMR and allograft survival.
Sixty-seven of 334 patients (20%) had HLA-DSA. The incidence of clinical/subclinical AMR at day 200 posttransplant was significantly higher in patients with HLA-DSA than in patients without HLA-DSA (55% vs. 6%; P<0.0001). Notably, 30/67 patients with HLA-DSA (45%) did not experience clinical/subclinical AMR. Death-censored 5-year allograft survival was equal in patient without HLA-DSA and patients with HLA-DSA but no AMR (89% vs. 87%; P=0.95), whereas it was 20% lower in patients with HLA-DSA and AMR (68%; P=0.002). The number, class, and cumulative strength of HLA-DSA determined by SAFB, and prior sensitizing events were not predictive for the occurrence of AMR.
These results support the utility of SAFB for pretransplant risk assessment and organ allocation, and suggest that improvement of the positive predictive value of HLA-DSA defined by SAFB will require an enhanced definition of pathogenic factors of HLA-DSA.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Cadaver</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Graft Rejection - epidemiology</subject><subject>Graft Rejection - pathology</subject><subject>Histocompatibility Testing - methods</subject><subject>HLA Antigens - immunology</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Isoantibodies - blood</subject><subject>Isoantibodies - immunology</subject><subject>Kidney Transplantation - immunology</subject><subject>Living Donors</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Preoperative Care</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Tissue Donors - statistics & numerical data</subject><subject>Tissue, organ and graft immunology</subject><subject>Young Adult</subject><issn>0041-1337</issn><issn>1534-6080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1r20AQxZfQkjhp_4JC2UtzUzqzq9VKR9f5BENM7LvYj1mzRZZUrZyQ_z4yMS30ktMc5vceM-8x9g3hCqHSP8f-CiygJIklGkUg8xM2QyXzrIASPrEZQI4ZSqnP2HlKvwFASa1P2RlWCkRVwIxtF01sozMNf6KGnk3riHeBrwYaB9OmvjHtyK-7thuydU8uhuj4_XLO5-0YbecjJX5NI7mRPLevfB3bbUPZYbullt823Uv2i4xPX9jnYJpEX4_zgm1ubzaL-2z5ePewmC8zl2s1ZsJbnVvCQhzOEzaEXHpji6rMEYKxymhy1oApdREqlRuvhECpPVkR0MsLdvlu2w_dnz2lsd7F5KiZ3qBun-pCSykUVB-CAlEKLMoJlO-gG7qUBgp1P8SdGV5rhPrQQ71Z1f_3MKm-H-33dkf-n-YY_AT8OAImTemHKWwX019OoCp0iSDfALypkbI</recordid><startdate>20090615</startdate><enddate>20090615</enddate><creator>AMICO, Patrizia</creator><creator>HÖNGER, Gideon</creator><creator>MAYR, Michael</creator><creator>STEIGER, Jürg</creator><creator>HOPFER, Helmut</creator><creator>SCHAUB, Stefan</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>20090615</creationdate><title>Clinical Relevance of Pretransplant Donor-Specific HLA Antibodies Detected by Single-Antigen Flow-Beads</title><author>AMICO, Patrizia ; HÖNGER, Gideon ; MAYR, Michael ; STEIGER, Jürg ; HOPFER, Helmut ; SCHAUB, Stefan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-2db74be16229602bff43dab698410fab5a7ecba0a876f954ad522137deb2f1d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Biopsy</topic><topic>Cadaver</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Graft Rejection - epidemiology</topic><topic>Graft Rejection - pathology</topic><topic>Histocompatibility Testing - methods</topic><topic>HLA Antigens - immunology</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Isoantibodies - blood</topic><topic>Isoantibodies - immunology</topic><topic>Kidney Transplantation - immunology</topic><topic>Living Donors</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Preoperative Care</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Tissue Donors - statistics & numerical data</topic><topic>Tissue, organ and graft immunology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>AMICO, Patrizia</creatorcontrib><creatorcontrib>HÖNGER, Gideon</creatorcontrib><creatorcontrib>MAYR, Michael</creatorcontrib><creatorcontrib>STEIGER, Jürg</creatorcontrib><creatorcontrib>HOPFER, Helmut</creatorcontrib><creatorcontrib>SCHAUB, Stefan</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>AMICO, Patrizia</au><au>HÖNGER, Gideon</au><au>MAYR, Michael</au><au>STEIGER, Jürg</au><au>HOPFER, Helmut</au><au>SCHAUB, Stefan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical Relevance of Pretransplant Donor-Specific HLA Antibodies Detected by Single-Antigen Flow-Beads</atitle><jtitle>Transplantation</jtitle><addtitle>Transplantation</addtitle><date>2009-06-15</date><risdate>2009</risdate><volume>87</volume><issue>11</issue><spage>1681</spage><epage>1688</epage><pages>1681-1688</pages><issn>0041-1337</issn><eissn>1534-6080</eissn><coden>TRPLAU</coden><abstract>Defining the clinical relevance of donor-specific HLA-antibodies detected by single-antigen flow-beads (SAFB) is important because these assays are increasingly used for pretransplant risk assessment and organ allocation. The aims of this study were to investigate to which extent HLA-DSA detected by SAFB represent a risk for antibody-mediated rejection (AMR) and diminished allograft survival, and to define HLA-DSA characteristics predictive for AMR.
In this retrospective study of 334 patients with negative complement-dependent cytotoxicity crossmatches, day-of-transplant sera were analyzed by SAFB, HLA-DSA determined by virtual crossmatching, and the results correlated with the occurrence of AMR and allograft survival.
Sixty-seven of 334 patients (20%) had HLA-DSA. The incidence of clinical/subclinical AMR at day 200 posttransplant was significantly higher in patients with HLA-DSA than in patients without HLA-DSA (55% vs. 6%; P<0.0001). Notably, 30/67 patients with HLA-DSA (45%) did not experience clinical/subclinical AMR. Death-censored 5-year allograft survival was equal in patient without HLA-DSA and patients with HLA-DSA but no AMR (89% vs. 87%; P=0.95), whereas it was 20% lower in patients with HLA-DSA and AMR (68%; P=0.002). The number, class, and cumulative strength of HLA-DSA determined by SAFB, and prior sensitizing events were not predictive for the occurrence of AMR.
These results support the utility of SAFB for pretransplant risk assessment and organ allocation, and suggest that improvement of the positive predictive value of HLA-DSA defined by SAFB will require an enhanced definition of pathogenic factors of HLA-DSA.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>19502960</pmid><doi>10.1097/tp.0b013e3181a5e034</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Biological and medical sciences Biopsy Cadaver Drug Therapy, Combination Female Fundamental and applied biological sciences. Psychology Fundamental immunology Graft Rejection - epidemiology Graft Rejection - pathology Histocompatibility Testing - methods HLA Antigens - immunology Humans Immunosuppressive Agents - therapeutic use Isoantibodies - blood Isoantibodies - immunology Kidney Transplantation - immunology Living Donors Male Medical sciences Middle Aged Preoperative Care Retrospective Studies Risk Assessment Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Tissue Donors - statistics & numerical data Tissue, organ and graft immunology Young Adult |
| title | Clinical Relevance of Pretransplant Donor-Specific HLA Antibodies Detected by Single-Antigen Flow-Beads |
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