Enzyme-Linked Immunosorbent Assay for Human Leukocyte Antigen Antibody Detection and Urine Protein Test Recommended for Follow-Up Monitoring After Renal Transplantation

Kobayashi, Takaaki; Katayama, Akio; Kohara, Setsuko; Nagasaka, Takaharu; Goto, Norihiko; Ueki, Tsuneo; Uchida, Kazuharu; Nakao, Akimasa

doi:10.1097/tp.0b013e318170f79f

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…This study also showed that patients with HLA class II antibodies had higher serum Cr levels than those with class I antibodies, like our previous study using ELISA [7]. Although ELISA would be inadequate for early detection of CAMR because of its much lower sensitivity than the Luminex assay, LAT-M was found to exhibit no false-positive results.…”

Section: Discussionsupporting

confidence: 51%

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Significant association between chronic antibody-mediated rejection and donor-specific antibodies against HLA-DRB rather than DQB in renal transplantation

Kobayashi¹,

Maruya²,

Niwa³

et al. 2011

Human Immunology

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Section: Discussionsupporting

confidence: 51%

“…We previously reported that enzyme-linked immunosorbenty assay (ELISA)-detected HLA antibody, particularly against HLA class II was related to renal dysfunction in maintenance renal transplant recipients [7]. However, sensitivity and specificity are reportedly different between assay methods for HLA antibody detection.…”

Section: Introductionmentioning

confidence: 98%

Significant association between chronic antibody-mediated rejection and donor-specific antibodies against HLA-DRB rather than DQB in renal transplantation

Kobayashi¹,

Maruya²,

Niwa³

et al. 2011

Human Immunology

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“…After successful treatment of acute rejection, the surviving patients maintained stable renal function and urinary protein‐to‐creatinine ratios, although those producing de novo antibodies showed slightly higher protein‐to‐creatinine ratios by the end of the first year post‐transplant. In a previous report, the authors found that, among patients with de novo antibodies, graft function was worse in those with proteinuria than in those without, suggesting that proteinuria is a risk factor for a worse prognosis in patients with de novo antibodies . The authors also proposed that early screening for anti‐HLA antibodies is important to avoid graft damage in such cases.…”

Section: Discussionmentioning

confidence: 99%

Dynamics of anti‐human leukocyte antigen antibodies after renal transplantation and their impact on graft outcome

Souza

David‐Neto

Panajotopolous

et al. 2014

Clinical Transplantation

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The purpose of this study was to sequentially monitor anti-HLA antibodies and correlate the results with antibody-mediated rejection (AMR), graft survival (GS), and graft function (GF). We collected sera from 111 kidney transplant recipients on transplant days 0, 7, 14, 30, 60, 90, 180, and 360 and analyzed PRA levels by ELISA. DSAs were analyzed by single-antigen beads in rejecting kidneys. At pre-transplant, 79.3% of the patients were non-sensitized (PRA = 0%) and 20.7% were sensitized (PRA > 1%). After transplant, patients were grouped by PRA profile: no anti-HLA antibodies pre- or post-transplant (group HLApre-/post-; n = 80); de novo anti-HLA antibodies post-transplant (group HLApre-/post+; n = 8); sensitized pre-transplant/increased PRA post-transplant (group HLApre+/post↑; n = 9); and sensitized pre-transplant/decreased PRA post-transplant (group HLApre+/post↓; n = 14). De novo anti-HLA antibodies were detected at 7-180 d. In sensitized patients, PRA levels changed within the first 30 d post-transplant. Incidence of AMR was higher in HLApre-/post+ and HLApre+/post↑ than in HLApre-/post-, and HLApre+/post↓ (p < 0.001) groups. One-yr death-censored GS was 36% in group HLApre+/post↑, compared with 98%, 88% and 100% in groups HLApre-/post-, HLApre-/post+, and HLApre+/post↓, respectively (p < 0.001). Excluding first-year graft losses, GF and GS were similar among the groups. In conclusion, post-transplant antibody monitoring can identify recipients at higher risk of AMR.

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“…By contrast, antibody‐mediated injury is an important predictor of graft loss, making C4d staining and DSA testing a key part of the evaluation process. However, C4d staining is not always reliable and it has been suggested that findings of microvascular damage in the biopsy [42] and proteinuria [43] should be considered more valuable predictors of graft loss, in combination with DSA testing.…”

Section: Managing Graft Deterioration: Practical Considerationsmentioning

confidence: 99%

Challenges and considerations in diagnosing the kidney disease in deteriorating graft function

Ekberg

Johansson

2012

Transplant International

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SummaryDespite significant reductions in acute-rejection rates with the introduction of calcineurin inhibitor (CNI)-based immunosuppressive therapy, improvements in long-term graft survival in renal transplantation have been mixed. Improving long-term graft survival continues to present a major challenge in the management of kidney-transplant patients. CNIs are a key component of immunosuppressive therapy, and chronic CNI toxicity has been widely thought to be a major factor in late graft failure. However, recent studies examining the causes of late graft failure in detail have challenged this view, highlighting the importance of antibody-mediated rejection and other factors. In addition, the diagnosis of CNI nephrotoxicity represents a challenge to clinicians, with the potential for over-diagnosis and an inappropriate reduction in immunosuppressive therapy. When graft function is deteriorating, accurately determining the cause of the kidney disease is essential for effective long-term management of the patient. Diagnosis requires a thorough clinical investigation, and in the majority of cases a specific cause can be identified.

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Enzyme-Linked Immunosorbent Assay for Human Leukocyte Antigen Antibody Detection and Urine Protein Test Recommended for Follow-Up Monitoring After Renal Transplantation

Cited by 5 publications

References 30 publications

Significant association between chronic antibody-mediated rejection and donor-specific antibodies against HLA-DRB rather than DQB in renal transplantation

Significant association between chronic antibody-mediated rejection and donor-specific antibodies against HLA-DRB rather than DQB in renal transplantation

Dynamics of anti‐human leukocyte antigen antibodies after renal transplantation and their impact on graft outcome

Challenges and considerations in diagnosing the kidney disease in deteriorating graft function

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