Solid phase testing in the HLA laboratory: implications for organ allocation

Abstract

This piece was originally requested as a white paper from the Scientific and Clinical Affairs Committee of the American Society for Histocompatibility and Immunogenetics (ASHI), of which the author was then Chairman. Upon review by the ASHI Board of Directors and the Editors of their journal, it was considered too controversial for publication. It is intended to be provocative and controversial; it is not intended as a review of the literature. Though written with a decided 'American point of view', it is of importance that the issues facing US transplantation and laboratory testing efforts are shared to varying degrees by the international community, and who, unlike some of their American cousins, may be able to tolerate a spirited discussion. Sadly, we sometimes forget that dissent from dogma can be fun!

Back to the future: application of contemporary technology to long-standing questions about the clinical relevance of human leukocyte antigen-specific alloantibodies in renal transplantation

“…The CDC cross-match test has now been abandoned by some transplant centers and reliance instead is on a combination of flow cytometric analysis and solid-phase binding assays [42]. Our view is that the CDC test for antibody screening and donor T-and B-cell cross-matching should be retained because it allows differentiation between high and intermediate levels of immunological risk.…”

Next-generation sequencing: the solution for high-resolution, unambiguous human leukocyte antigen typing

“…It is only after such complete analysis that the relevance of non-ARS mismatches can be determined. Although high-resolution typing has been traditionally used for bone marrow transplantation, disease association studies, and population genetics, recent observations indicate that high-resolution typing may also be important in solid organ transplantation where allele specific antibody has been observed [27][28][29][30].…”

Immunogenicity and Allogenicity: A Challenge of Stem Cell Therapy

“…In addition, because the FCXM is a semiquantitative measure of antibody binding, it can be less subjective than visual assessment of cell death in complementdependent assays. The virtual cross-match approach, in which antibodies are characterized in solid phase assays prior to cross-matching, was reported to predict a negative flow cross-match in greater than 90% of cases [53,54]. However, a potential disadvantage of the virtual crossmatch approach is that transplants may be excluded based on antibody results with unknown clinical relevance.…”