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Sensitive HLA antibody testing and the risk of antibody-mediated rejection and graft failure.
Debyser, Tim; Callemeyn, Jasper; Coemans, Maarten; Kerkhofs, Johan; Koshy, Priyanka; Kuypers, Dirk; Senev, Aleksandar; Tambur, Anat R; Van Loon, Elisabet; Wellekens, Karolien; Naesens, Maarten; Emonds, Marie-Paule.
Afiliación
  • Debyser T; Department of Microbiology, Immunology and Transplantation, Nephrology and Kidney Transplantation Research Group, KU Leuven, Leuven, Belgium.
  • Callemeyn J; Department of Microbiology, Immunology and Transplantation, Nephrology and Kidney Transplantation Research Group, KU Leuven, Leuven, Belgium.
  • Coemans M; Department of Microbiology, Immunology and Transplantation, Nephrology and Kidney Transplantation Research Group, KU Leuven, Leuven, Belgium.
  • Kerkhofs J; Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross Flanders, Mechelen, Belgium.
  • Koshy P; Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium.
  • Kuypers D; Department of Microbiology, Immunology and Transplantation, Nephrology and Kidney Transplantation Research Group, KU Leuven, Leuven, Belgium.
  • Senev A; Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium.
  • Tambur AR; Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross Flanders, Mechelen, Belgium.
  • Van Loon E; Comprehensive Transplant Center, Northwestern University, Chicago, Illinois, USA.
  • Wellekens K; Comprehensive Transplant Center, Northwestern University, Chicago, Illinois, USA.
  • Naesens M; Department of Microbiology, Immunology and Transplantation, Nephrology and Kidney Transplantation Research Group, KU Leuven, Leuven, Belgium.
  • Emonds MP; Department of Microbiology, Immunology and Transplantation, Nephrology and Kidney Transplantation Research Group, KU Leuven, Leuven, Belgium.
HLA ; 103(6): e15586, 2024 06.
Article en En | MEDLINE | ID: mdl-38932739
ABSTRACT
Solid phase detection and identification of HLA antibodies in kidney transplantation currently relies on single antigen bead (Luminex®) assays, which is more sensitive than the previously used enzyme-linked immunosorbent assays (ELISA). To evaluate the impact of more sensitive HLA testing on antibody-mediated rejection (AMR) occurrence and allograft survival, we analysed 1818 renal allograft recipients transplanted between March 2004 and May 2021. In 2008, solid phase testing switched from ELISA to Luminex. We included 393 (21.6%) transplantations before and 1425 (78.4%) transplantations after transition from ELISA- to Luminex-based testing. For this study, bio-banked ELISA era samples were tested retrospectively with Luminex. Significantly less pretransplant DSA were found in patients transplanted with pre-existing HLA antibodies in the Luminex (109/387) versus the ELISA period (43/90) (28% vs. 48%, p < 0.01). Throughout histological follow-up, 169 of 1818 (9.3%) patients developed AMR. After implementing Luminex-based testing, the rate of AMR significantly decreased (p = 0.003). However, incidence of graft failure did not significantly differ between both eras. In conclusion, less patients with pretransplant DSA were transplanted since the implementation of Luminex HLA testing. Transition from ELISA- to Luminex-based HLA testing was associated with a significant decrease in AMR occurrence post-transplantation. Since the decline of AMR did not translate into improved graft survival, Luminex-based testing has the added value of preventing low-risk AMR cases. Therefore, Luminex' high sensitivity must be balanced against waiting time for a suitable organ.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Prueba de Histocompatibilidad / Trasplante de Riñón / Rechazo de Injerto / Supervivencia de Injerto / Antígenos HLA / Isoanticuerpos Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: HLA Año: 2024 Tipo del documento: Article País de afiliación: Bélgica Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Prueba de Histocompatibilidad / Trasplante de Riñón / Rechazo de Injerto / Supervivencia de Injerto / Antígenos HLA / Isoanticuerpos Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: HLA Año: 2024 Tipo del documento: Article País de afiliación: Bélgica Pais de publicación: Reino Unido