PMID: 30814077Mar 1, 2019Paper

Epitope Analysis Aids in Transplant Decision Making by Determining the Clinical Relevance of Apparent Pre-Transplant Donor Specific Antibodies (DSA)

Annals of Clinical and Laboratory Science
Soumya Pandey, Terry O Harville

Abstract

Pre-transplantation work-up on a patient with end stage renal disease using Single Antigen Bead (SAB) testing showed significant anti-HLA-B*44:02 (>5,000 MFI) and anti-HLA-B*44:03 (>1,000 MFI) antibodies, with persistence on quarterly testing. No significant Class II anti-HLA antibodies were present. The patient received a potential offer from a living unrelated-donor expressing HLA-B*44:02. Based on the presence of anti-HLA-B*44:02 antibody, the crossmatch (XM) was predicted to be positive. However, the actual fluorescence cytometry crossmatch (FCXM) was negative. FCXM and Complement Dependent Cytotoxicity-XM (CDC-XM) studies with three surrogate donors who expressed HLA-B*44:02 (and no other potential confounding HLA types) were also negative. Additional assays were performed for detecting anti-HLA antibodies. Immucor® LSA® SAB analyses also revealed presence of anti-HLA-B*44:02 and anti-HLA-B*44:03 antibodies. However, One Lambda® Antigen Trays, C1q analysis, and iBeads®, did not detect elevated anti-HLA-B*44:02 and/or anti-HLA-B*44:03 antibodies. An extensive evaluation of all exposed and non-exposed epitopes expressed by the patient and the donor was performed to identify the non-shared epitopes between them. The donor spe...Continue Reading

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