Frequent False-Positive Reactions in Pronase-Treated T-Cell Flow Cytometric Cross-match Tests

Park, H.; Lim, Young Mi; Han, Byung Hoon; Hyun, Jungwon; Song, Eun Young; Park, M.H.

doi:10.1016/j.transproceed.2011.12.048

Cited by 26 publications

(10 citation statements)

References 7 publications

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“…described that non‐HLA antibodies may occur as alloantibodies, yet they seem to be predominantly autoantibodies . Therefore the positive reactions to FCXM in this case could be a consequence of autoantibodies . Though pre‐formed DSAbs causing AMR are mostly reactive to HLA, several reports suggest that non‐HLA antibodies can also lead to AMR.…”

Section: Discussionmentioning

confidence: 73%

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Probable C4d‐negative accelerated acute antibody‐mediated rejection due to non‐HLA antibodies

et al. 2015

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We report a case of probable C4d-negative accelerated acute antibody-mediated rejection due to non-HLA antibodies. A 44 year-old male was admitted to our hospital for a kidney transplant. The donor, his wife, was an ABO minor mismatch (blood type O to A) and had Gitelman syndrome. Graft function was delayed; his serum creatinine level was 10.1 mg/dL at 3 days after transplantation. Open biopsy was performed immediately; no venous thrombosis was observed during surgery. Histology revealed moderate peritubular capillaritis and mild glomerulitis without C4d immunoreactivity. Flow cytometric crossmatching was positive, but no panel-reactive antibodies against HLA or donor-specific antibodies (DSAbs) to major histocompatibility complex class I-related chain A (MICA) were detected. Taken together, we diagnosed him with probable C4d-negative accelerated antibody-mediated rejection due to non-HLA, non-MICA antibodies, the patient was treated with steroid pulse therapy (methylprednisolone 500 mg/day for 3 days), plasma exchange, intravenous immunoglobulin (40 g/body), and rituximab (200 mg/body) were performed. Biopsy at 58 days after transplantation, at which time S-Cr levels were 1.56 mg/dL, found no evidence of rejection. This case, presented with a review of relevant literature, demonstrates that probable C4d-negative accelerated acute AMR can result from non-HLA antibodies.

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Section: Discussionmentioning

confidence: 73%

“…For example, Amico et al . showed that non‐HLA antibodies account for 2.3% of AMR cases occurring within 7 days after kidney transplantation (10 of 433 cases) . To date, several non‐HLA antibodies have been identified, including those reactive to angiotensin type 1 receptor, vimentin, and the glomerular basement membrane protein agrin.…”

Section: Discussionmentioning

confidence: 99%

Probable C4d‐negative accelerated acute antibody‐mediated rejection due to non‐HLA antibodies

et al. 2015

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“…The implementation of pronase pretreatment of lymphocytes in the FCXM has been shown to decrease the false positive rate 50 as well as increase sensitivity of the B-cell crossmatch without disrupting MHC expression. 51 Interestingly, however, cases of false positives B-cell and T-cell crossmatches following pronase treatment have been reported 52,53 and are likely due to non-HLA antibodies, autoantibodies that recognize exposed epitopes upon pronase treatment, or an artifact resulting from the use of extremely high concentrations of pronase. In the scenario outlined above in which the FCXM is positive and VXM is negative, transplantation does not represent an increased risk to the patient.…”

Section: Future Of Crossmatchingmentioning

confidence: 99%

Out with the old, in with the new: Virtual versus physical crossmatching in the modern era

Morris

Sullivan

Krummey

et al. 2019

HLA

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The virtual crossmatch (VXM) is gaining acceptance as an alternative approach to assess donor:recipient compatibility prior to transplantation. In contrast to a physical crossmatch, the virtual crossmatch does not require viable donor cells but rather relies on complete HLA typing of the donor and current antibody assessment of the recipient. Thus, the VXM can be performed in minutes which allows for faster transplant decisions thereby increasing the likelihood that organs can be shipped across significant distances yet safely transplanted. Here, we present a brief review of the past 50 years of histocompatibility testing; from the original complement‐dependent cytotoxicity crossmatch in 1969 to the new era of molecular HLA typing, solid‐phase antibody testing and virtual crossmatching. These advancements have shaped a paradigm shift in our approach to transplantation. That is, foregoing a prospective physical crossmatch in favor of a VXM. In this review, we undertake an in‐depth analysis of the pros‐ and cons‐ of physical and virtual crossmatching.Finally, we provide objective data on the selected use of the VXM which demonstrate the value of a VXM in lieu of the traditional physical crossmatch for safe and efficient organ transplantation.

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“…Non-HLA antibodies existed in 2.3% of ABMR cases occurring within 7 days after kidney transplantation [63,64]. Representative non-HLA antibodies included MICA, MICB, and angiotensin type 1 receptor [AT1R] antibodies [65][66][67][68].…”

Section: Dsa Positivitymentioning

confidence: 99%

Histopathological findings in transplanted kidneys

et al. 2017

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Improvements in immunosuppression have reduced acute kidney allograft rejection and clinicians are now seeking ways to prolong allograft survival to 20 years and beyond. The primary cause of kidney allograft loss is still chronic rejection, followed by death with a functioning allograft and primary kidney disease recurrence. Thus, overcoming kidney allograft rejection remains the most important issue. Kidney allograft rejection can be classified into two types: T cell-and antibody-mediated rejection. Both are diagnosed pathologically based on the Banff 2013 classification. Other important pathological features in addition to rejection include calcineurin inhibitor toxicity, polyomavirus nephropathy, and recurrence of the primary kidney disease. Here, we review the diagnosis and representative features of histopathological findings in transplanted kidneys.

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Frequent False-Positive Reactions in Pronase-Treated T-Cell Flow Cytometric Cross-match Tests

Cited by 26 publications

References 7 publications

Probable C4d‐negative accelerated acute antibody‐mediated rejection due to non‐HLA antibodies

Probable C4d‐negative accelerated acute antibody‐mediated rejection due to non‐HLA antibodies

Out with the old, in with the new: Virtual versus physical crossmatching in the modern era

Histopathological findings in transplanted kidneys

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