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Keywords:
Donor-Specific Antibodies
Panel reactive antibody
Panel reactive antibody
Donor-Specific Antibodies
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Panel reactive antibody
Histocompatibility Testing
Histocompatibility
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臓器移植におけるHLA抗体検査には，ドナーリンパ球を用いたクロスマッチ検査，抽出HLA抗原や精製HLA 分子をコーティングした合成ビーズによるPRA（Panel reactive antibody）法などさまざまな検査法が考案されている。しかし，検査法によって検出感度の相違，検出されたドナー特異的抗体DSA（Donor specific alloantibody）の免疫グロブリン（class・subclass）の相違，自然抗体または自己抗体などnon-HLA抗体が反応する場合もあり結果判定が難しいのが現状である。本講演では，HLA抗体検査について当施設で日常実施している検査法および解析法を紹介する。
Subclass
Panel reactive antibody
Histocompatibility Testing
HLA-A
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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.
Panel reactive antibody
Tissue typing
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Objective To investigate the significance of donor specific antibody(DSA) and panel reactive antibody(PRA)testing in renal transplant.Methods One hundred and twenty-eight recipients from October,2007 to December,2009.were tested PRA using ELISA HLA-I,II antigen plate provided by One lambda and GTI.The antibody monitoring system(AMS,GTI Inc)is a solid enzyme-linked immunosorbent assay(ELISA)crossmatch test for the detection of immunoglobulin G(IgG)antibody to donor-specific solubilized HLA class I and class II antigens.Results Both PRA and DSA showed different degree positive in 3 points(pre-transplant,post-transplant and recovery)in 13 patients,in which 9 patients received second transplant and 4 patients received first transplant.Conclusion Both DSA and PRA testing are important in renal transplant.
Panel reactive antibody
Donor-Specific Antibodies
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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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Objective To evaluate the clinical application of HLA matching in highly sensitized recipients of renal allografts.Methods Recipient's panel reactive antibody (PRA) was detected by using ELISA test with Lambda antigen tray (LAT).Donor and recipient HLA classⅠtyping was performed with special monoclonal tray,and HLA classⅡgene typing with micro-sequence specific primers (Micro-SSP).Results There were 104 recipients with anti-HLA class-ⅠIgG antibody,76 with anti-HLA class-ⅡIgG antibody,and 44 with both anti-HLA class-1 and anti HLA class-ⅡIgG antibody respectively in 136 sensitized recipients.HLA class-ⅠIgG antibody positive rate was 11%-97 %,with an average of 49.6%±23.8%;The common public epitopes antibody was not found in each recipient of 13 cases with PRA＜20%,but was found in I2 recipients in 44 cases with PRA be- tween 20%-50%,and 39 recipients in 47 cases with PRA＞50%.HLA class-ⅡIgG antibody posi- tive rate was 17%-100%,with an average of 28.2%±63.8%.The number of cases of 0,1,2,3, 4 MM was 7 (5.1%),26 (19.1%),47 (34.6%),39 (28.7%) and 17 (12.5%) respectively by the standard of conventional HLA antigen matching;however the number of the recipients with 0,1, 2,3 MM was 31 (22.8%),53 (39.0%),36 (26.5%) and 16 (11.7%) respectively according to the rule of HLA CREGs matching and none with 4 MM.Rates of acute rejection in sensitized recipi- ents with 2MM and 3MM HLA-CREGs were 25.0% and 37.5% respectively and were significantly higher than those with 0MM (P＜0.05,＜0.05 respectively).Kidney year-survival was decreased when the number of MM of HLA CREGs matching increased.Conclusion The HLA CREGs matching can improve the ratio of well-matched significantly.Good HLA matching can reduce the incidence of acute rejection in sensitized recipients and increase the survival rate of grafts.
Panel reactive antibody
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Donor-Specific Antibodies
HLA-C
Histocompatibility Testing
Histocompatibility
Isoantibodies
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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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