Effects of Different Sensitization Events on HLA Alloimmunization in Solid Organ Transplantation Patients

Hyun, Jungwon; Park, K.D.; Yoo, Young Mi; Lee, B.; Han, Byung Hoon; Song, Eun Young; Park, M.H.

doi:10.1016/j.transproceed.2011.12.049

Cited by 65 publications

(55 citation statements)

References 10 publications

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“…22 Therefore, plasma renin activity (PRA) tests determine the organ transplantation probability of the patient whose presensitization level is low and cross-match test is found as negative before transplantation. 23 The methods used for HLA antibody detection has been developed in the last 10 years. 24 It is known that HLA antibodies are IgG type.…”

Section: Importance Of the Anti-hla Antibodies In Transplantationmentioning

confidence: 99%

Importance of Pregnancy Induced Paternal HLA Antibody Production in Transplantation: Review

Gürbüz¹,

Soyöz²,

Ayna³

et al. 2016

Turkiye Klinikleri J Med Sci

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Section: Importance Of the Anti-hla Antibodies In Transplantationmentioning

confidence: 99%

Importance of Pregnancy Induced Paternal HLA Antibody Production in Transplantation: Review

Gürbüz¹,

Soyöz²,

Ayna³

et al. 2016

Turkiye Klinikleri J Med Sci

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“…4,5 Several studies have evaluated whether alloimmunization after previous transfusion, pregnancy, and transplant is associated with a significantly higher prevalence of anti-HLA antibodies. 6,7 In the 1980s, many transplant centers performed blood transfusions before kidney transplant to improve allograft survival. 8 Subsequently, this shared protocol was discarded because of the high risk of anti-HLA antibody sensitization and infection.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Resse¹,

Paolillo²,

Minucci³

et al. 2018

Exp Clin Transplant

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Objectives: Human leukocyte antigen alloimmunization is caused by exposure to HLA antigens through transfusion, pregnancy, or transplant. Our study objective was to present the rate of positivity of anti-HLA antibody considering the effects of a single sensitization event in kidney transplant candidates at our center. Materials and Methods: Our study reviewed 606 kidney transplant candidates. Patient sera were analyzed using Luminex xMAP technology. Panel reactive antibody positivity rates and antibody strengths in patients were analyzed according to a single sensitization event. Results: Our findings showed 246 patients (40.6%) with a panel reactive antibody > 0, of which 97 (39.4%) were sensitized from a single event, 119 (48.4%) were sensitized by multiple events, and 30 (12.2%) had no known sensitizing event. Considering patients sensitized by a single event with a panel reactive antibody > 0, we found that 25.8% had received transplant only, 49.5% had previous pregnancy only, and 24.7% had received transfusion only. The strength of antibodies was significantly higher in patients with previous transplant procedures than in those with transfusion for HLA-A (P < .01), HLA-B (P < .05), HLA-C (P < .05), HLA-DR (P < .001), HLA-DQ (P < .05), and HLA-DP (P < .05). Similarly, we observed significantly higher median fluorescence intensity values for HLA-A, -DR, -DQ, and -DP loci in patients with a previous transplant procedure versus preg nancy. The strength of antibodies against HLA-DR was significantly higher in patients with a previous pregnancy compared with those with transfusion (P < .01). Conclusions: This study documents the profile of HLA alloimmunization in kidney transplant candidates. In particular, transplant procedures appear to have a greater immunologic impact, followed by pregnancy and transfusion. Our data confirm and are in accordance with those of several studies in which the sensitization events were associated with higher prevalence of anti-HLA antibodies.

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“…These recommendations are irrespective of the relation of the recipient with the donor, and they apply to recipients with the highest risk for sensitization such as patients with revision transplant, multigravida women, and recipients with a history of transfusion. 1,4,[15][16][17] The different types of desensitization protocols have been reviewed, 4 and the present review will focus on the practical approach to these sensitized patients who are potential candidates for kidney transplant. This approach relies on an integrated analysis of several medical, economic, and logistic parameters that will enable the transplant team and the National Organization for Organ Sharing and Transplant (NOOST) in the decision-making about the suitability and feasibility of kidney transplant in these high-risk patients.…”

Section: Introductionmentioning

confidence: 99%

“…Although PRA level, measured by enzyme-linked immunosorbent assay or flow cytometry, is an estimate of previously formed HLA antibodies, flow cytometry (Luminex, Austin, TX USA) single antigen donor-specific antibody assay, a multiple beads-based technology that is not yet available in many countries, offers a more sensitive and accurate tool to assess the type and the strength of each donor-specific antibody. 4,9,11,17 A shortcoming of the Luminex test is the lack of information about whether antibodies identified by Luminex can activate complement and harm the allograft. 4 Crossmatches of both B and T cells between recipient-donor pairs are determined with 2 complementary techniques: complement-dependent cytotoxic and flow cytometry assays (the latter being more sensitive) provide a negative cutoff and allow the assessment of crossmatch strength.…”

Section: Introductionmentioning

confidence: 99%

“…4 Approach to transplant from living donor Every potential kidney transplant recipient from a living donor has a baseline quantitative PRA determined by flow cytometry screening or, preferably, Luminex technique; dual crossmatch by complementdependent cytotoxic and flow cytometry techniques; and measurement of donor-specific antibodies by flow cytometry (preferably Luminex) before transplant. 1,4,[15][16][17] Historical crossmatch and/or donorspecific antibody titers are out of any type of immunologic conditioning such as statin, intravenous immunoglobulin, or anti-cluster of differentiation 20 (anti-CD20). The positive result of either test (crossmatch and donor-specific antibodies) is an absolute contraindication for transplant and an indication for desensitization, which is applied according to the level of risk for ABMR (Tables 1 and 2; Figure 2).…”

Section: Introductionmentioning

confidence: 99%

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Approach to Kidney Transplant in Sensitized Potential Transplant Recipients

Barbari

Abbas²,

Jaafar³

2012

Exp Clin Transplant

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More than one-third of patients on waiting lists for kidney transplant are sensitized. Most have previously formed donor-specific and non-donorspecific serum antibodies and/or positive crossmatch by complement-dependent cytotoxity and/or flow cytometry. Two categories of alloantibodies include antibodies against major histocompatibility complex human leukocyte antigen class 1 and class 2 and antibodies against minor histocompatibility complex. A current positive crossmatch is an absolute contraindication for transplant. Positive historical panel reactive antibody and/or donor-specific antibodies (human leukocyte antigen and minor histocompatibility complex), even in the absence of a historical positive crossmatch, are associated with an increased risk for allosensitization, antibodymediated rejection, and accelerated graft failure. Desensitization protocols are numerous, complex, and expensive. It is recommended to perform a systematic determination of historical and current panel reactive antibody, donor-specific antibodies (human leukocyte antigen and minor histocompatibility complex), and crossmatch by the most sensitive assays. The risk of sensitization may be estimated from the combined results of the crossmatch with the donor and those of the recipient's panel reactive antibody and donor-specific antibodies at baseline. The adoption of a scoring system for risk stratification may facilitate the task of organ allocation for sensitized patients. Recipients with an estimated sensitization risk ≥ high may be referred preferably to the national waiting priority list and informed about the financial and the medical risks that may incur with future transplant. Sensitized patients at high risk for antibody-mediated rejection may benefit from a structured monitoring process involving systematic and regular immunologic, histologic, and functional assessments of the graft after transplant. We recommend the adoption and regular updating of these approaches to ensure safe and appropriate therapeutic standards in these sensitized patients, in accordance with best clinical practice.

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Effects of Different Sensitization Events on HLA Alloimmunization in Solid Organ Transplantation Patients

Cited by 65 publications

References 10 publications

Importance of Pregnancy Induced Paternal HLA Antibody Production in Transplantation: Review

Importance of Pregnancy Induced Paternal HLA Antibody Production in Transplantation: Review

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Approach to Kidney Transplant in Sensitized Potential Transplant Recipients

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