SR Kankonkar*

Consultant, (HOD), Histocompatibility and Tx Immunology Lab, Goa Medical College and Hospital, Bambolim, Goa, India

*Corresponding Author: SR Kankonkar, Consultant, (HOD), Histocompatibility and Tx Immunology Lab, Goa Medical College and Hospital, Bambolim, Goa, India.

Received: May 16, 2022; Published: June 10, 2022

Abstract

Anti HLA antibodies are significant impediments in kidney transplantation. In 1969, Terasaki and Patel [1] reported association of hyper-acute renal allograft rejection with preformed lymphocytotoxic antibodies. Since then, various methodologies were introduced and adopted to study the role of HLA antibodies in acceptance/rejection mechanism of allograft Transplantation. Aim of the present study is to detect, analyse and evaluate anti HLA antibodies, pre and post transplantation in sensitised patients, using Solid Phase LABSCan3D (Luminex) Technology.

The present study comprised 12 clinical cases and 10 normal subjects for detection of HLA antibodies class I and II IDs PRA and L-SBA Cl I and CLII antigens, using LABSCan3D Luminex solid phase technology and CDC (T and B cells) XM.

Out of 12 cases having clinical history, 4 were females (parous), age between 43 -57 years and 8 males, age 35- 56 years. 3 females and one male who had a H/O Chronic rejection, were studied and found highly sensitised, cPRA >90%; MFI >21,150, L- SBA> 20,000 and CDC (T and B cell) XM was strongly positive. It was found that after 2 years of Tx, 2 patients were positive for HLA antibodies and had cPRA 66%, MFI > 1600, L-SBA > 1500 and another patient was weakly positive for IDs class I and II, and L-SBA Cl II. 1 patient, after one year of cadaver Tx and 3 patients before Tx, all were negative for antibodies.

Out of 2 transfused patients, one was weakly positive for ID Cl I, MFI 1225-1415, positive for Cl II MFI 1163-8136 and also positive for L-SBA Cl II, MFI 2000-4200. However, this patient was negative for Cl I SBA MFI <1000.

Total 7 patients were positive and 5 were negative for HLA antibodies. The results were compared with (CDC) XM. Only 2 patients were studied for Luminex XM (DSA) with Lysate, and results were found comparable.

Availability of solid-phase HLA antibody testing enhanced renal Tx outcome, especially monitoring Pre and Post Tx HLA antibodies, selection of donors and suitable choice of drug regimes. However, in the present study, due to non- availability of HLA typing, it was not possible to rule out and correlate Donor Specific Antibody (DSA) or production of De Novo antibodies or both in positive cases.

Keywords: De Novo; Panel Reactive Antibodies; Screening

References

1. Patel R and Terasaki PI. “Significance of the positive cross match test in kidney transplantation”. The New England Journal of Medicine 280 (1969): 735-739.
2. Colvin RB. “Antibody-mediated renal allograft rejection: diagnosis and pathogenesis”. Journal of the American Society of Nephrology 18 (2007): 1046-1056.
3. Süsal C., et al. “HLA antibodies and the occurrence of early adverse events in the modern era of transplantation: a collaborative transplant study report”. Transplantation 87 (2009): 1367-1371.
4. Wiebe C., et al. “Evolution and clinical pathologic correlations of de novo donor specific HLA antibody post kidney transplant”. American Journal of Transplantation 12 (2012): 1157-1167.
5. Loupy A., et al. “The impact of donor specific anti-HLA antibodies on late kidney allograft failure”. Nature Reviews Nephrology 8 (2012): 348-357.
6. Kissmeyer-Nielsen F., et al. “Hyperacute rejection of kidney Allografts, associated with pre-existing humoral antibodies against donor cells”. Lancet 2 (1966): 662-665.
7. Süsal C., et al. “No association of kidney graft loss with human leukocyte antigen antibodies detected exclusively by sensitive Luminex single-antigen testing: a Collaborative Transplant Study report”. Transplantation 91 (2011): 883-887.
8. Cecka JM., et al. “Calculated PRA: initial results show benefits for sensitized patients and a reduction in positive crossmatches”. American Journal of Transplantation 11 (2011): 719-724.
9. van den Berg-Loonen EM., et al. “Clinical relevance of pre-transplant donor-directed antibodies Detected by single antigen beads in highly sensitized renal transplant patients”. Transplantation 85 (2008): 1086-1090.
10. Montgomery RA., et al. “Desensitization in HLA-incompatible kidney recipients and survival”. The New American Society of Nephrology 365 (2011): 318-326.
11. Stegall MD., et al. “A comparison of plasmapheresis versus high-dose IVIG desensitization renal allograft recipients with high levels of donor specific alloantibody”. American Journal of Transplantation 6 (2006): 346-351.
12. Amos DB., et al. “A simple microcyte toxicity test”. Transplantation 7 (1969): 220.
13. Amico P., et al. “Clinical relevance of pretransplant donor-specific HLA antibodies detected by single-antigen flow-beads”. Transplantation 87 (2009): 1681-1688.
14. Gebel HM., et al. “Pre-transplant assessment of donor-reaction, HLA-specific antibodies in renal transplantation : contraindication vs. risk”. American Journal of Transplantation 3 (2003): 1488-1500.
15. Lefaucheur C., et al. “Pre-exinting donor specific HLA antibodies predict outcome in kidney transplantation”. American Society of Nephrology 21 (2010): 1398-1406.
16. Carner Susal., et al. “Rple and value of Luminex Detected HLA Antibodies before and after kidney Transplantation”. KARGER, Transfusion Medicine and Hemotherapy3 (2013): 190-195.
17. Stegall MD., et al. “A comparison of plasmapheresis versus high dose IVIG desensitization in renal allograft recipients with high levels of donor specific alloantibody”. American Journal of Transplantation 6 (2006): 346-351.
18. Zachary A., et al. “Quantifying HLA-specific antibodies in patients undergoing desensitization”. Current Opinion in Organ Transplantation 16 (2011): 410-415.

Citation

Citation: SR Kankonkar. “Need for Screening Presence/Absence of HLA Antibodies Before and/or After Transplantation". Acta Scientific Microbiology 5.7 (2022): 29-34.

Copyright

Copyright: © 2022 SR Kankonkar. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.