Flow crossmatch results in combination with 2 different single antigen assays provide greater resolution in predicting renal graft survival

Hdl Handle:
http://hdl.handle.net/10147/239140
Title:
Flow crossmatch results in combination with 2 different single antigen assays provide greater resolution in predicting renal graft survival
Authors:
Keegan, D; Kelly, J; O'Neill, D; Keogan, M
Citation:
Transplant International (2011) 24 SUPPL. 2 (357). : September 2011
Publisher:
Wiley-Blackwell
Journal:
Transplant International
Issue Date:
Sep-2011
URI:
http://hdl.handle.net/10147/239140
Additional Links:
http://onlinelibrary.wiley.com/doi/10.1111/j.1432-2277.2011.01353.x/abstract
Abstract:
Detection of HLA-specific antibodies pre-transplant helps prevent graft rejection, and aids risk assessment of donor-recipient pairs. Initial enthusiasm and widespread adoption of Luminex single antigen (SAB) assays has been tempered by conflicting reports of their clinical relevance. Aims: To assess effects of Luminex-detected antibodies on long-term graftsurvival, alone or in combination with a second Luminex assay and flow cytometry cross-matching. Methods: Day of transplant sera from 204 sensitized renal transplant recipients were retrospectively analysed for the presence of donor-specific HLA antibodies (DSA) using HLA One Lambda Labscreen® (Canoga Park, CA) and Genprobe Lifecodes® (Stamford, CT) SAB. Results: 122 patients (55%) had detectable DSA. When all antibodies were considered positive, there was no statistically significant difference in graft survival (>80% in both groups). This confirmed the suspicion that not all antibodies detected are clinically relevant, and that the non-significant subset of antibodies detected was masking clinically relevant antibodies. When only antibodies detectable by both methods are considered true positives, the result was highly significant (p<0.001). Survival rates in negative patients were >80% ten years post-transplant, and patients with single technique antibodies also had excellent graft survival after ten years (>80%). In contrast, graft survival in patients with antibodies confirmed by both Luminex assays was <80% approximately 2 years post-transplant, dropping to approximately 50% after ten years. When flow-cytometry crossmatch results were correlated with SAB results, patients with confirmed antibodies and a positive crossmatch had significantly worse outcomes than confirmed antibody positive/crossmatch negative patients (graft survival at 2 years 64% vs >90%; p<0.002). Conclusions: SAB assays alone are inadequate to risk assess a donorrecipient pair. However, when used in combination together with flowcytometry crossmatching, they facilitate detailed risk assessment.
Item Type:
Conference Presentation
Language:
en
Keywords:
TRANSPLANTATION

Full metadata record

DC FieldValue Language
dc.contributor.authorKeegan, Den_GB
dc.contributor.authorKelly, Jen_GB
dc.contributor.authorO'Neill, Den_GB
dc.contributor.authorKeogan, Men_GB
dc.date.accessioned2012-08-20T09:36:59Z-
dc.date.available2012-08-20T09:36:59Z-
dc.date.issued2011-09-
dc.identifier.citationTransplant International (2011) 24 SUPPL. 2 (357). : September 2011en_GB
dc.identifier.urihttp://hdl.handle.net/10147/239140-
dc.description.abstractDetection of HLA-specific antibodies pre-transplant helps prevent graft rejection, and aids risk assessment of donor-recipient pairs. Initial enthusiasm and widespread adoption of Luminex single antigen (SAB) assays has been tempered by conflicting reports of their clinical relevance. Aims: To assess effects of Luminex-detected antibodies on long-term graftsurvival, alone or in combination with a second Luminex assay and flow cytometry cross-matching. Methods: Day of transplant sera from 204 sensitized renal transplant recipients were retrospectively analysed for the presence of donor-specific HLA antibodies (DSA) using HLA One Lambda Labscreen® (Canoga Park, CA) and Genprobe Lifecodes® (Stamford, CT) SAB. Results: 122 patients (55%) had detectable DSA. When all antibodies were considered positive, there was no statistically significant difference in graft survival (>80% in both groups). This confirmed the suspicion that not all antibodies detected are clinically relevant, and that the non-significant subset of antibodies detected was masking clinically relevant antibodies. When only antibodies detectable by both methods are considered true positives, the result was highly significant (p<0.001). Survival rates in negative patients were >80% ten years post-transplant, and patients with single technique antibodies also had excellent graft survival after ten years (>80%). In contrast, graft survival in patients with antibodies confirmed by both Luminex assays was <80% approximately 2 years post-transplant, dropping to approximately 50% after ten years. When flow-cytometry crossmatch results were correlated with SAB results, patients with confirmed antibodies and a positive crossmatch had significantly worse outcomes than confirmed antibody positive/crossmatch negative patients (graft survival at 2 years 64% vs >90%; p<0.002). Conclusions: SAB assays alone are inadequate to risk assess a donorrecipient pair. However, when used in combination together with flowcytometry crossmatching, they facilitate detailed risk assessment.en_GB
dc.language.isoenen
dc.publisherWiley-Blackwellen_GB
dc.relation.urlhttp://onlinelibrary.wiley.com/doi/10.1111/j.1432-2277.2011.01353.x/abstracten_GB
dc.subjectTRANSPLANTATIONen_GB
dc.titleFlow crossmatch results in combination with 2 different single antigen assays provide greater resolution in predicting renal graft survivalen_GB
dc.typeConference Presentationen
dc.identifier.journalTransplant Internationalen_GB
dc.description.provinceLeinsteren
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