Human leukocyte antigen antibody incompatible renal transplantation

Krishnan, N.; Zehnder, Daniel; Briggs, David; Higgins, Robert

doi:10.4103/0971-4065.106029

Cited by 7 publications

(7 citation statements)

References 36 publications

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“…Human leukocyte antigen alloimmunization in candidates for renal transplantation is a reality [18] , [19] and knowledge of the incidence of sensitization to HLA antigens in the Brazilian population may be important for advances in renal transplantation and to minimize the waiting time for candidates [19] .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Humoral Immune Response to Human Leukocyte Antigens in Brazilian Renal Transplant Candidates

Saito

Yamakawa

Aparecida³

et al. 2014

PLoS ONE

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Pre-transplant sensitization to human leukocyte antigens (HLA) is a risk factor for graft failure. Studies of the immunological profile related to anti-HLA antibodies in Brazilian renal transplant candidates are few. In this study, we evaluated the humoral immune response to HLA antigens in 269 renal transplant candidates, in Paraná State, Brazil. The HLA typing was performed by the polymerase chain reaction sequence-specific oligonucleotide method (PCR-SSO) combined with Luminex technology, using an SSO-LABType commercial kit (One Lambda, Inc., Canoga Park, CA, USA). The percentages of panel-reactive antibodies (PRA) and the specificity of anti-HLA antibodies were determined using the LS1PRA and LS2PRA commercial kits (One Lambda, Inc.). The PRA-positive group consisted of 182 (67.7%) patients, and the PRA-negative group of 87 (32.3%) patients. The two groups differed significantly only with respect to gender. Females were the most sensitized. Among the 182 patients with PRA- positive, 62 (34.1%) were positive for class I and negative for class II, 39 (21.4%) were negative for class I and positive for class II, and 81 (44.5%) were positive for both classes I and II. The HLA-A*02, A*24, A*01, B*44, B*35, B*15, DRB1*11, DRB1*04 and DRB1*03 allele groups were the most frequent. The specificities of anti-HLA antibodies were more frequent: A34, B57, Cw15, Cw16, DR51, DQ8 and DP14. This study documented the profile of anti-HLA antibodies in patients with chronic renal failure who were on waiting lists for an organ in Paraná, and found high sensitization to HLA antigens in the samples.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Humoral Immune Response to Human Leukocyte Antigens in Brazilian Renal Transplant Candidates

Saito

Yamakawa

Aparecida³

et al. 2014

PLoS ONE

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“…The conventional complement-dependent lymphocytotoxicity (CDC) crossmatch is a traditional method for detection of human leukocyte antigen antibodies in patients awaiting kidney transplantation. 1,2 The CDC crossmatch (CDCXm) technique was performed to identify patients with a higher risk of developing hyperacute graft rejection (HAR) mediated by pre-formed donor-specific antibody (DSA). Such antibodies are formed as a result of previous exposure to HLA, generally through pregnancy, blood transfusion or previous transplantation.…”

Section: Introductionmentioning

confidence: 99%

The good, the bad, and the ugly of luminex donor‐specific crossmatch

Chowdhry

Makroo

Thakur

et al. 2018

HLA

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The presence of donor-specific antibodies directed against human leukocyte antigen significantly influences renal transplant because of antibody-mediated rejection. We performed the screening of pre-renal transplant patients for preformed anti-HLA antibodies using anti-human globulin augmented-complement-dependent lymphocytotoxicity crossmatch (AHG-CDCXm), luminex donor-specific crossmatch (LumXm) and HLA antibody screening. Seven hundred and fifty-four patients were assessed for LumXm. HLA antibody screening was possible in 325 out of 754 cases. All the three investigations viz. CDCXm, HLA antibody screening and LumXm was performed in 325 patients. All CDCXm positive patients (10/325, 3.08%) were also positive with LumXm and HLA antibody screen whereas 14 cases (4.31%) with CDCXm negative were positive with luminex-based assays. LumXm and HLA antibody screening were both positive in 24 (7.38%) cases, LumXm and HLA antibody screening were both negative in 275 (84.63%) cases and LumXm negative and HLA antibody screening was positive in 22 (6.76%) cases. However, there were four cases (1.23%) which were positive in LumXm in spite of being negative in HLA antibody testing. Single Antigen Bead (SAB) assay was performed in all patients positive for HLA antibody test. We suggest that LumXm is a useful and sensitive technique for the detection of anti-HLA antibodies in pre-transplant renal patients. However, other measures such as luminex antibody screen, SAB assay, history of the donor, and the class of antibodies involved should be taken into consideration for pre-transplant work up of renal patients.

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“…Because the presence of anti-ABO antibody in the recipient is a risk for AMR, reducing antibody levels plays a key role in the success of the transplantation 10. Another study reported that high preoperative antibody titer did not have a significant effect on AMR, instead emphasizing the importance of preventing new antibody production after transplantation 11. Although the amount of acceptable pre-transplantation anti ABO antibody titer is not standardized for ABOi LDLT, desensitization protocols have been directed toward the elimination of anti-ABO antibody titers and suppression of B cell activity before and after transplantation.…”

Section: Discussionmentioning

confidence: 99%

ABO-incompatible liver transplantation using only rituximab for patients with low anti-ABO antibody titer

Lee

Choi

Han

et al. 2019

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims Graft survival after ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has increased due to advances in desensitization methods. We analyzed early outcomes following ABOi LDLT using only rituximab without any additional desensitization methods in recipients with low anti-ABO antibody titers (≤1:32). Methods Ten adult patients underwent ABOi LDLT between September 2014 and December 2016. All patients were administered a single dose of rituximab (300 mg/m 2 ) prior to LDLT. Three patients with baseline anti-ABO titer >1:32 underwent multiple sessions of plasmapheresis to reduce titers to <1:32 (rituximab+plasmapheresis, RP). Seven patients with low anti-ABO titer (≤1:32) did not undergo plasmapheresis (rituximab-only, RO). ABO-compatible LDLT patients during the same period were included for comparison (n=22). Results Post-transplantation titers were significantly lower in the RO than in the RP and showed no rebound rise (POD7 1.14±0.38 vs 28.0±31.7, p =0.04), (POD30 1.26±0.45 vs 108±107, p =0.02). There were no significant differences in rejection, biliary complications and infection between groups. There were no significant differences in outcome between the RO group and ABO-compatible except for infection. Conclusions This study shows that recipients with low baseline anti-ABO antibody titer (≤1:32) can undergo ABOi LDLT using conventional immunosuppression and rituximab alone.

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Human leukocyte antigen antibody incompatible renal transplantation

Cited by 7 publications

References 36 publications

Evaluation of the Humoral Immune Response to Human Leukocyte Antigens in Brazilian Renal Transplant Candidates

Evaluation of the Humoral Immune Response to Human Leukocyte Antigens in Brazilian Renal Transplant Candidates

The good, the bad, and the ugly of luminex donor‐specific crossmatch

ABO-incompatible liver transplantation using only rituximab for patients with low anti-ABO antibody titer

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