Results of Questionnaire Survey of Current Immune Monitoring Practice of Transplant Clinicians and Clinical Pathologists in Korea: Basis for Establishment of Harmonized Immune Monitoring Guidelines

Abstract

Detection of significant alloimmune response, which affects graft function and survival by effective immune monitoring, is critical for treatment decision making. However, there is no consensus regarding immune monitoring (IM) for kidney transplantation (flow KT) in Korea. The IM protocol may be affected by the level of immunological risk, the methods of desensitization and the availabilities of resources such as laboratory support and cost of tests. Questionnaire surveys designed to identify the current practi- Until now, the immunological monitoring of alloimmune responses are focused on the detection of rejection events in practice than detection of adverse immune activity which might be preceded clinically or pathologically evident rejection signs. It might be rather because there were no reliable and well validated laboratory methods to be applicable.However, luminex bead technologies used for the detection of antibodies in antigen, allele or epitope levels for HLA(7-9) and non-HLA systems(15), and molecular technologies to detect transcript signatures of diverse immunologic changes are broadening our choice of tests(16-18).And it is continuously reflected on diagnostic criteria such as Banff criteria (19,20). However, the diagnostic criteria does not specify the practical way of immune monitoring in real world, so, there is no standardized guidelines and is Immune monitoring protocolsAbout 28% (9/32) of clinicians from 6 institutes (6/25, 24%) are performing protocol biopsies at various time points and the number of biopsy depending on the level of immunological risks (Fig. 3). When higher the risk, more frequent biopsies are being performed within posttransplant 12 weeks (Fig. 4). Clinicians are applying different combinations of HLA antibody tests in different time points and also depending on the level of immunological risks. Antibody monitoring is being performed frequently at posttransplant 3∼4 weeks, 24 weeks and yearly (Fig. 5). Antibody screening test is used for low risk patients, however for high risk patients, HLA antibody phenotyping or SAB identification tests are used more frequently (Fig. 6). The suggested time points of HLA antibody monitoring test in patients waiting for kidney transplantation was questioned regardless of current protocols (Fig. 7). Twenty-four out of 26 (92%) respondents answered that the presence of HLA antibody needed to be checked at registration in KONOS regardless of immunological risk levels, and for living donor kidney transplant (LDKT) candidates, it is suggested to do within pre-transplant 4 weeks. Twelve (46%) respondents replied that the monitoring of HLA antibody is necessary if the patients had recent transfusion or pregnancy episodes.As on-demand test when the rejection is suspected clinically, 70% (22/32) of respondents answered proceeding to HLA antibody test but 15% (5/32) answered to do HLA antibody test when the pathologic finding of AMR in biopsy identified (Fig. 8).2. sponses needs to be cautious because it may be rather because not all the instit...

Liver Failure Has Higher IgG ABO Blood Group Isoagglutinin Titer than Kidney Failure

“…These results were different from a previous study reporting that ABOi KT recipients had a median IgG IA titer of 1:64 initially [30]. The initial IgM IA titer of the KT and LT recipients in the present study was 6.0 (1:64), which is similar to the results of previous reports (1:8∼1:64) for group O Koreans [32,33]. The IA titration method can cause an IA titer discrepancy [27,34].…”