Pitfalls and ambiguities in antibody screening in patients with cardiac assist devices: The role of flow PRA beads

Schall, Cynthia; Klingman, L.; Cook, Deborah R.; Valdez, Riccardo

doi:10.1016/j.humimm.2005.08.016

Cited by 1 publication

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“…This activity was detectable 18 to 228 days (mean 81 days) after implantation and only after incubation with the anti‐human IgG detection antibody, demonstrating that this is an antibody response to non‐HLA determinants. Similar findings have been reported in LVAD patients receiving ABO identical, leucodepleted blood products, in which 10 of 11 LVAD patients were positive with all wells in an HLA ELISA within 60 days of LVAD implantation, but negative by CDC (15,16). This dubious reactivity in our series disappeared between 8 and 41 days (mean 19.83 ± 12.37) after transplantation (data not shown).…”

Section: Discussionsupporting

confidence: 85%

Sensitization Following LVAD Implantation Using Leucodepleted Blood Is Not Due to HLA Antibodies

Newell

Smith

Rogers

et al. 2006

American Journal of Transplantation

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Implantation of left ventricular assist devices (LVAD)is associated with HLA antibody sensitization. The objective of this study was to determine the specificity of antibodies produced by LVAD recipients using a combination of ELISA, Luminex and microcytotoxicity assays. Fifty-one LVAD patients were studied, from 44 to 838 days post-implantation. No patient developed HLA antibodies, although 24 produced IgG antibodies detectable in both ELISA and Luminex assays. These antibodies manifest as positive reactions with class I and class II wells of the ELISA and also blank wells. In Luminex assays, they produce high MFI readings with the negative control beads. Antibodies were detected 18 to 228 days after implantation. This reactivity was found to be directed against bovine serum albumin (BSA), commonly used to block non-specific binding in ELISA and Luminex assays; absorption of sera with BSA-coated beads completely abrogated reactivity in all solid phase assays, but did not eliminate anti-HLA antibodies in control sera. Ten of the 24 patients have proceeded to transplantation, with a 1-year graft survival of 69%. In conclusion, it appears that implantation of LVADS disrupts immunoregulatory pathways leading to production of anti-albumin antibodies. These can be misinterpreted as anti-HLA antibodies in solid phase assays.

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Section: Discussionsupporting

confidence: 85%