459: Positive Flow Cytometery Crossmatches and HLA Antibodies May Not Be Contraindications to Heart Transplantation
Ronald H. KermanRajko RadovancevicP.A. AllisonEva McKissickRoberta C. BogaevArthur BraceyS AllisonIgor D. GregoričO.H. Frazier
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Panel reactive antibody
Donor-Specific Antibodies
Objective To investigate the application and significance of human leukocyte antigen(HLA) and cross-reactive antigen groups(CREGs) matching in highly sensitized recipients of renal allografts.Methods Recipient's panel reactive antibody(PRA)was detected by using complement dependent-micro lymphocytotoxicity test with lambda cell tray.Donor and recipient HLA classⅠtyping was performed with special monoclonal tray and HLA classⅡgene typing with microsequence specific primers(Micro-SSP). Fourteen highly sensitized patients with PRA positive(PRA40%)were observed in HLA CREGs matching and outcome of post-transplantation.Results Patients with 0,1,2 or 3 mismatching(MM) of HLA CREGs+DR were 4(28%), 6(44%)and 4(28%)cases respectively according to the the rule of CREGs matching and no case had 3～6 MM.However the cases of 0,1,2,3 and 4 MM were 1(7%),3(21%),5(36%)and 5(36%)respectively by the standard of conventional HLA antigen matching,without 4～6 MM and only 4 cases had shared 0～1MM.Only 9 patients were developed into acute rejection, and were reversed by OKT3 treatment after transplantation.Renal function was returned to normal in all patients.Conclusions Using CREGs matching criteria would significantly increase the chance of recipients to receive well-matched kidney and provide more chance for waiting recipients.Suitable HLA matching could play an important role in reducing the incidence of acute rejection and improving graft survival in sensitized patients.
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We sought to investigate temporal trends in the methodology of human leukocyte antibody assessment in heart transplantation.The United Network for Organ Sharing database was queried from June 2004 to March 2013 to obtain pre-heart transplantation human leukocyte antibody results. The % panel reactive antibody for class I and II antibodies was recorded along with the methodology of assessment. Allosensitization was defined as class I and/or II panel reactive antibody of ≥ 10%. The primary outcome measure was graft survival.During the study period, 12,858 patients with available data underwent heart transplantation. The prevalence of allosensitization increased, with 16.8% in 2005-2006 sensitized at the time of transplantation compared to 23.1% in 2010-2011 (p < 0.001); this occurred in conjunction with an increase in the utilization of flow cytometry (77.2% in 2005-2006; 97.0% in 2010-2011, p < 0.001). Using multivariable analysis, a positive pre-heart transplantation panel reactive antibody by flow cytometry independently predicted graft loss.There has been a recent increase in flow cytometric assessment of human leukocyte antibodies prior to heart transplantation, which may be associated with an increase in the prevalence of pre-transplant patients being characterized as allosensitized. Flow cytometry may identify patients with the highest likelihood of graft loss.
Panel reactive antibody
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Panel reactive antibody
Donor-Specific Antibodies
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Heart transplants
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Panel reactive antibody
Donor-Specific Antibodies
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Human leukocyte antigen(HLA) is the key antigen mediating rejection and panel reactive antibody(PRA) represent anti-HLA antibodies in circulation.HLA typing and PRA testing are carried out generally before organ transplantation.With research on the relationship among HLA,PRA and heart transplantation developing,the value of HLA typing and PRA testing in heart transplantation has received more attention and their clinical using strategy has been improved.This article will review the strategy of HLA typing,the clinical value of HLA typing,time-selection in HLA typing,reason and mechanism of rising PRA,clinical sense of PRA testing and treatment of sensitized patients.
Panel reactive antibody
Tissue typing
Histocompatibility Testing
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Histocompatibility
Histocompatibility Testing
Panel reactive antibody
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Donor-Specific Antibodies
Clinical Significance
Panel reactive antibody
Graft rejection
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Objective To investigate the clinical implication of human leukocyte antigen(HLA)matching in sensitized recipients of renal transplantation.Methods Recipient's panel reactive antibody (PRA) was detected by using micro-complement-dependent-lymphocytotoxicity test with Lambda cell tray.Donor and recipient HLA class Ⅰ typing was performed with special monoclonal tray and HLA class Ⅱ gene typing with micro-sequence-specific-primers (Micro-SSP).Results PRA positive rate in 17 recipients was 5.1% to 80% with an average of 37.9%;patients with 0,1 or 2 mismatch (MM) of HLA crossreactive antigen group(CREGs) were 5(29%),8(47%)and 4(24%)cases respectively according to the rule of CREGs matching and no cases had 3-6 MM,however the cases of 0,1 or 2 MM were 1(6%),1(6%)and 8(47%) respectively by the standard of conventional HLA antigen matching and 7(41%)cases had 3-4 MM. Only 3 patients developed acute rejection and were reversed by OKT3 treatment.Renal function retumed normal in all patients.Conclusions The possibility of good matching was greatly enhanced by the CREGs matching.Good HLA matching plays an important role in reducing the incidence of acute rejection and in improving the survival of renal transplants.
Key words:
Human leukocyte antigen; Panel reactive antibody; Sensitized recipients; Kidney transplantation
Panel reactive antibody
Tissue typing
Histocompatibility Testing
HLA-A
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Antibody titer
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