Clinical relevance of pretransplant anti-HLA donor-specific antibodies: Does C1q-fixation matter?

Crespo, Marta; Torı́o, Alberto; Mas, V.; Redondo, Dolores; Pérez‐Sáez, María José; Mir, Marisa; Faura, Anna; Guerra, Rita; Montes-Ares, Olga; Checa, María Dolores; Pascual, Julio

doi:10.1016/j.trim.2013.07.002

Cited by 95 publications

(71 citation statements)

References 32 publications

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“…47 However, another study found C1q+DSA more likely to be of DQ specificity and also, associated with a 30% decrement in 5-year survival. 84 To bind complement, antibodies must be IgG1/3 isotope and be of sufficiently high titer; closer examination of these studies and others indicates that antibody amount (estimated albeit imperfectly by MFI) is the major predictor of C1q positivity and outcomes, 48,[84][85][86][87]117 and the role of this new assay in addition routine SAB testing remains to be fully determined.…”

Section: Dndsa and Features Of Amrmentioning

confidence: 99%

“…Extreme levels of MFI (.10,000) may correlate with complement-fixing C1q-positive DSA, 48,84-86 but these data do not show any increase in adverse outcomes with pretransplant C1q(+)DSA over standard DSA detection methods. 47,86,87 DSA with a Negative XM: Defining Risk Remains Challenging The increased sensitivity of SAB allows DSA to be detected even with a negative XM. 80,88,89 AMR rates of 20%-55% are reported under these circumstances, 22,23,83,88,90,91 with AMR negatively affecting the impact of DSA on graft survival in some studies 90 but not all.…”

Section: Utility Of Hla Antibody Testing Pretransplantmentioning

confidence: 99%

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Utility of HLA Antibody Testing in Kidney Transplantation

Konvalinka¹,

Tinckam

2015

Journal of the American Society of Nephrology

165

135

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HLA antigens are polymorphic proteins expressed on donor kidney allograft endothelium and are critical targets for recipient immune recognition. HLA antibodies are risk factors for acute and chronic rejection and allograft loss. Solid-phase immunoassays for HLA antibody detection represent a major advance in sensitivity and specificity over cell-based methods and are widely used in organ allocation and pretransplant risk assessment. Post-transplant, development of de novo donorspecific HLA antibodies and/or increase in donor-specific antibodies from pretransplant levels are associated with adverse outcomes. Although single antigen bead assays have allowed sensitive detection of recipient HLA antibodies and their specificities, a number of interpretive considerations must be appreciated to understand test results in clinical and research contexts. This review, which is especially relevant for clinicians caring for transplant patients, discusses the technical aspects of single antigen bead assays, emphasizes their quantitative limitations, and explores the utility of HLA antibody testing in identifying and managing important pre-and post-transplant clinical outcomes.

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Section: Dndsa and Features Of Amrmentioning

confidence: 99%

Section: Utility Of Hla Antibody Testing Pretransplantmentioning

confidence: 99%

Utility of HLA Antibody Testing in Kidney Transplantation

Konvalinka¹,

Tinckam

2015

Journal of the American Society of Nephrology

165

135

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“…Especially high HLA class II antibody levels are related to an increased risk of developing transplant glomerulopathy and C4d deposits in peritubular capillaries [43]. The diagnostic role of measuring C1q-fixing DSAs is still unclear [44], but might help to distinguish between clinically relevant and nonrelevant DSAs. The Transplantation Society has published guidelines for the detection of DSA after kidney transplantation that should be used as a basis for local decisions [45].…”

Section: Detection Of Hla Antibodiesmentioning

confidence: 99%

Acute and chronic antibody-mediated rejection in pediatric kidney transplantation

et al. 2014

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Acute antibody-mediated rejection is a diagnostic challenge in renal transplantation medicine. However, it is an important diagnosis to make, since chronic antibody-mediated rejection (CAMR) is the main cause of long-term graft loss. Antibody-mediated rejection is diagnosed by detecting donorspecific antibodies (DSAs) in the blood in combination with observing typical histomorphological signs in kidney biopsy, as described in the Banff classification. Therapy is based on the removal of DSAs by administering intravenous immunoglobulins (IVIGs), plasmapheresis, or immunoadsorption. Reoccurrence of antibodies is diminished by the use of rituximab, increased immunosuppression, and in some cases additional experimental substances. A combination of these techniques has been shown to be successful in the majority of cases of acute and chronic antibody-mediated rejection. Routine DSA monitoring is warranted for early detection of antibody-mediated rejection.

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“…In another recent study [25], the pre-transplant presence of class I DSAs (versus class II DSAs) predicted acute ABMR and graft loss.…”

Section: Classical Acute Antibody-mediated Rejectionmentioning

confidence: 93%

Acute Antibody-Mediated Rejection in Kidney Transplantation: Clinical and Therapeutic Aspects

E¹

2014

J Nephrol Ther

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Acute Antibody Mediated Rejection (ABMR) in kidney transplantation is a severe complication that frequently occurs after transplantation and is due either to pre-transplant Donor-Specific Antibodies (DSAs) or to de novo DSAs. New techniques to detect DSAs in the recipient serum and advances in the assessment of graft pathology have allowed us to recognize this entity in recent years.The treatment of ABMR is a multistep process consisting of the desensitization of the patients with preformed antibodies to prevent acute ABMR: in cases of acute ABMR, the antibodies are removed from the serum and anti-B cells immunosuppressants are used.

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Clinical relevance of pretransplant anti-HLA donor-specific antibodies: Does C1q-fixation matter?

Cited by 95 publications

References 32 publications

Utility of HLA Antibody Testing in Kidney Transplantation

Utility of HLA Antibody Testing in Kidney Transplantation

Acute and chronic antibody-mediated rejection in pediatric kidney transplantation

Acute Antibody-Mediated Rejection in Kidney Transplantation: Clinical and Therapeutic Aspects

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