Appearance of new CDC-reactive antibodies in patients waiting for kidney transplantation.
Antibody screening
HLA-antibodies
Kidney transplantation
Waiting list
Journal
Transplant immunology
ISSN: 1878-5492
Titre abrégé: Transpl Immunol
Pays: Netherlands
ID NLM: 9309923
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
30
06
2021
revised:
09
08
2021
accepted:
10
08
2021
pubmed:
16
8
2021
medline:
19
2
2022
entrez:
15
8
2021
Statut:
ppublish
Résumé
Patients awaiting kidney transplantation are regularly screened for HLA-antibodies, but there is scarce data about the optimal interval. Results from Complement-dependent cytotoxicity testing (CDC) for waitlisted patients were reviewed for increases in panel reactive antibodies (PRA) by at least 10%-points. Clinical records were screened for historic immunizing events and possible trigger factors preceding the PRA-increase. Additionally, non-pretransplanted men tested negative for HLA antibodies by solid-phase assays (SPA) out of their first two samples on the waiting list ("non-immunized men") were evaluated for detection of HLA antibodies by SPA during their further stay on the waiting list. 15,360 samples from 1928 patients tested by CDC were analyzed for changes in PRA. PRA-increases occurred most frequently in patients waitlisted recently for retransplantation (annual incidence 6%). Removal of previous transplants, severe infections and/or reduced immunosuppression triggered 65% of PRA-increases during the first year after waitlisting. Transfusions accounted for 55% of PRA-increases in later years. Leucocyte-reduced red blood cell units not only boosted historic antibodies, but even induced primary immunization. In the second part of the study, 6780 samples tested by SPA from 703 non-immunized men were evaluated for development of HLA-antibodies. Only 9 men (1.3%) turned HLA antibody-positive (annual incidence 0.4%). A uniform screening interval does not fit all: Frequencies should be highest in patients newly waitlisted for re-transplant and lowest in non-immunized men. Transfused patients should be monitored closely for development of HLA-antibodies even if leukoreduced products are used.
Sections du résumé
BACKGROUND
Patients awaiting kidney transplantation are regularly screened for HLA-antibodies, but there is scarce data about the optimal interval.
METHODS
Results from Complement-dependent cytotoxicity testing (CDC) for waitlisted patients were reviewed for increases in panel reactive antibodies (PRA) by at least 10%-points. Clinical records were screened for historic immunizing events and possible trigger factors preceding the PRA-increase. Additionally, non-pretransplanted men tested negative for HLA antibodies by solid-phase assays (SPA) out of their first two samples on the waiting list ("non-immunized men") were evaluated for detection of HLA antibodies by SPA during their further stay on the waiting list.
RESULTS
15,360 samples from 1928 patients tested by CDC were analyzed for changes in PRA. PRA-increases occurred most frequently in patients waitlisted recently for retransplantation (annual incidence 6%). Removal of previous transplants, severe infections and/or reduced immunosuppression triggered 65% of PRA-increases during the first year after waitlisting. Transfusions accounted for 55% of PRA-increases in later years. Leucocyte-reduced red blood cell units not only boosted historic antibodies, but even induced primary immunization. In the second part of the study, 6780 samples tested by SPA from 703 non-immunized men were evaluated for development of HLA-antibodies. Only 9 men (1.3%) turned HLA antibody-positive (annual incidence 0.4%).
CONCLUSION
A uniform screening interval does not fit all: Frequencies should be highest in patients newly waitlisted for re-transplant and lowest in non-immunized men. Transfused patients should be monitored closely for development of HLA-antibodies even if leukoreduced products are used.
Identifiants
pubmed: 34391884
pii: S0966-3274(21)00089-7
doi: 10.1016/j.trim.2021.101449
pii:
doi:
Substances chimiques
HLA Antigens
0
Isoantibodies
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
101449Informations de copyright
Copyright © 2021 Elsevier B.V. All rights reserved.