The role of the histocompatibility laboratory in desensitization for transplantation

Current Opinion in Organ Transplantation

Volumn 14, Issue 4, 2009, Pages 398-402

  Leffell, Mary S ^a   Zachary, Andrea A ^a  

^a JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

Antibody monitoring; Desensitization; HLA specific antibodies; Intravenous immunoglobulin

Indexed keywords

HLA ANTIBODY; IMMUNOGLOBULIN; RITUXIMAB;

ANTIBODY DETECTION; DESENSITIZATION; FLOW CYTOMETRY; HISTOCOMPATIBILITY; HUMAN; IMMUNOASSAY; REVIEW; TRANSPLANTATION;

ANTIBODIES; ANTIBODY SPECIFICITY; DESENSITIZATION, IMMUNOLOGIC; GRAFT REJECTION; HISTOCOMPATIBILITY; HISTOCOMPATIBILITY TESTING; HLA ANTIGENS; HUMANS; IMMUNOASSAY; IMMUNOGLOBULINS, INTRAVENOUS; IMMUNOSUPPRESSIVE AGENTS; LABORATORIES; ORGAN TRANSPLANTATION; PLASMAPHERESIS; TISSUE DONORS; TREATMENT OUTCOME;

EID: 68049123449     PISSN: 10872418     EISSN: 15317013     Source Type: Journal    
DOI: 10.1097/MOT.0b013e32832c5983     Document Type: Review

References (30)

1. Montgomery RA, Zachary AA, Racusen LC, et al. Plasmapheresis and intravenous immune globulin provides effective rescue therapy for refractory humoral rejection and allows kidneys to be successfully transplanted into cross-match positive recipients. Transplantation 2000; 70:887-895.
2. Zachary AA, Montgomery RA, Jordan SC, et al. 14th International HLA and Immunogenetics Workshop: report on understanding antibodies in transplantation. Tissue Antigens 2007; 69:160-173. (Pubitemid 46625878)
3. Jordan SC, Peng A, Vo AA. Therapeutic strategies in management of the highly HLA-sensitized and ABO-incompatible transplant recipients. Contrib Nephrol 2009; 162:13-26.
4. Vo AA, Lukovsky M, Tovoda M, et al. Rituximab and intravenous immune globulin for desensitization during renal transplantation. N Engl J Med 2008; 359:242-250. (Pubitemid 352008439)
5. Stegall MD, Gloor J, Winter JL, et al. A comparison of plasmapheresis versus high-dose IVIG desensitization in renal allograft recipients with high levels of donor specific alloantibody. Am J Transplant 2006; 6:346-351. (Pubitemid 43382170)
6. Magee CC, Felgueiras J, Tinckam K, et al. Renal transplantation in patients with positive lymphocytotoxicity crossmatches: one center's experience. Transplantation 2008; 86:96-103.
7. Lefaucher C, Suberbielle-Boissel C, Hill GS, et al. Clinical relevance of performed HLA donor-specific antibodies in kidney transplantation. Am J Transplant 2008; 8:324-331.
8. Jordan SC, Pescovitz MD. Presensitization: the problem and its management. Clin J Am Soc Nephrol 2006; 1:421-432.
9. Zachary AA, Leffell MS. Detecting and monitoring human leukocyte antigen-specific antibodies. Human Immunol 2008; 69:591-604. This paper is a comprehensive review that provides not only the relevant antibody characteristics and types of tests needed for thorough antibody analysis, but also the extent of testing required for patients undergoing desensitization.
10. Vaidya S, Hilson B, Sheldon S, et al. DP reactive antibody in a zero mismatch renal transplant pair. Human Immunol 2007; 68:947-949.
11. Goral S, Prak EL, Kearns J, et al. Performed donor-directed anti-HLA-DP antibodies may be an impediment to successful kidney transplantation. Nephrol Dial Transplant 2008; 23:390-392. (Pubitemid 351767424)
12. Duquesnoy RJ, Awadalla Y, Lomago J, et al. Retransplant candidates have donor-specific antibodies that react with structurally defined HLA-DR, DQ, DP epitopes. Transplant Immunol 2008; 18:352-360. (Pubitemid 350302034)
13. Deng CT, El-Awar N, Ozawa M, et al. Human leukocyte antigen class II DQ alpha and beta epitopes identified from sera of kidney allograft recipients. Transplantation 2008; 86:452-459.
14. Jackson AM, Zachary AA. The problem of transplanting the sensitized patient: whose problem is it? Front Biosci 2008; 13:1396-1412.
15. Vaidya S, Partlow D, Susskind B, et al. Prediction of crossmatch outcome of highly sensitized patients by single and/or multiple antigen bead luminex assay. Transplantation 2006; 82:1524-1528. (Pubitemid 44967637)
16. Bingaman AW, Murphey CL, Palma-Vargas J, Wright F. A virtual crossmatch protocol significantly increases access of highly sensitized patients to deceased donor kidney transplantation. Transplantation 2008; 86:1864-1868.
17. Zachary AA, Montgomery RA, Leffell MS. Defining unacceptable HLA antigens. Cur Opin Organ Transplant 2008; 13:405-410.
18. Reinsmoen NL, Lai C, Vo A, et al. Acceptable donor-specific antibody levels allowing for successful deceased and living donor kidney transplantation after desensitization therapy. Transplantation 2008; 86:820-825. This article provides an exemplary approach to correlating results from solid-phase immunoassays with cross-match tests and clinical outcomes. The authors further illustrate the utility of using such data to define antibody levels that are predictable of successful desensitization and transplantation.
19. Tambur AR, Leventhal J, Kaufman DB, et al. Tailoring antibody testing and how to use it in the calculated panel reactive antibody era: the Northwestern University experience. Transplantation 2008; 86:1052-1059. These authors illustrate the value of a comprehensive pretransplant evaluation of sensitization, correlating fluorescence values in SPI with antibody titrations to characterize sera.
20. Bielmann D, Honger G, Lutz D, et al. Pretransplant risk assessment in renal allograft recipients using virtual crossmatching. Am J Transplant 2007; 7:626-632. (Pubitemid 46376450)
21. Van den Ber-Loonen EM, Billen EVA, Voorter CEM, et al. Clinical relevance of pretransplant donor-directed antibodies detected by single antigen beads in highly sensitized renal transplant patients. Transplantation 2008; 85:1086-1090.
22. Leffell MS, Locke JE, Houp JA, et al. Successful transplantation of patients with low level donor HLA specific antibody without desensitization treatment. Transplantation 2008; 86 (2S):184.
23. Gloor JM, Moore B, Schneider BA, et al. The effect of antithymocyte globulin on antihuman leukocyte antigen antibody detection assays. Transplantation 2007; 84:258-264. (Pubitemid 47205761)
24. Gloor JM, DeGoey S, Ploeger N, et al. Persistence of low levels of alloantibody after desensitization in crossmatch-positive living-donor kidney transplantation. Transplantation 2004; 78:221-227. (Pubitemid 39525342)
25. Zachary AA, Montgomery RA, Leffell MS. Factors associated with and predictive of persistence of donor-specific antibody after treatment with plasmapheresis and intravenous immunoglobulin. Human Immunol 2005; 66:364-370.
26. Locke JE, Zachary AA, Mohammed BS, et al. Rescue splenectomy for severe acute antibody-mediated rejection. Clinical Transplant 2006: 518-520.
27. Bartel G, Regele H, Wahrmann M, et al. Posttransplant HLA alloreactivity in stable kidney transplant recipients: incidences and impact on long-term allograft outcomes. Am J Transplant 2008; 8:2652-2660. This study examined the incidence among 34 stable kidney transplant recipients of both IgG-specific antibodies and C4d fixation using a modified single-antigen bead assay. Fifteen percent of patients tested positive for C4d fixing antibodies and 15% were found to have donor-specific antibodies, suggesting that low levels of antibody posttransplant may not be associated with poor outcomes.
28. Higgins R, Hathaway M, Lowe D, et al. Blood levels of donor-specific human leukocyte antigen antibodies after renal transplantation: resolution of rejection in the presence of circulating donor-specific antibody. Transplantation 2007; 84:876-884. (Pubitemid 351338949)
29. Burns JM, Cornell LD, Perry DK, et al. Alloantibody levels and acute humoral rejection early after positive crossmatch kidney transplantation. Am J Transplant 2008; 8:2684-2694. These authors have correlated results from solid-phase immunoassays and flow cytometry cross-matches with clinical outcomes. Their data clearly indicate that development of high levels of DSA posttransplant is associated with AMR and that either flow cytometry or SPI can be used for monitoring these levels.
30. Shapiro R. Reducing antibody levels in patients undergoing transplantation. N Engl J Med 2008; 359:305-306. (Pubitemid 352008447)