HLA-A, B, C, DRB1, DQB1 matching heterogeneity in ‘favourably matched’ kidney recipients

Rees, Margaret Tracey; Darke, C.

doi:10.1016/s0966-3274(03)00017-0

Cited by 9 publications

(4 citation statements)

References 25 publications

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“…Experimental and clinical data suggest that other classical and non-classical loci also influence outcomes after organ transplantation. [31][32][33][34] The heterogeneity of the MHC (and HLA in particular) makes allocation of organs by all MHC gene products unrealistic. Yet, despite the variability of MHC and HLA, the limited HLA MM in the current study significantly influenced outcomes after lung transplantation.…”

Section: Discussionmentioning

confidence: 99%

HLA mismatches influence lung transplant recipient survival, bronchiolitis obliterans and rejection: Implications for donor lung allocation

Peltz

Edwards²,

Jessen

et al. 2011

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 99%

HLA mismatches influence lung transplant recipient survival, bronchiolitis obliterans and rejection: Implications for donor lung allocation

Peltz

Edwards²,

Jessen

et al. 2011

The Journal of Heart and Lung Transplantation

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“…This effect is explained by the higher accuracy of genotyping, which corrected the previous serological errors. Although the three mismatch-defining HLA gene loci A, B, and DR are regarded as the most important criteria, an increasing number of studies have discovered the adverse effects of graft survival in pre-sensitized recipients due to other mismatched HLA-loci [20][21][22][23][24]. Research provides evidence that a high degree of compatibility, including all polymorphous HLA-gene loci, is an important aspect for medium-term (one up to five years) and long-term (more than five years) graft survival and exceedingly for successful regrafting.…”

Section: Discussionmentioning

confidence: 99%

Generation of Unexpected Allele-Specific Anti-HLA Antibodies after the Transplantation of a Fully-Matched Kidney Allograft and the Diagnostic Approaches Required for Excluding Harmful Effects after Subsequent Renal Regrafts

Schlaf¹,

Kehlen²,

Wahle³

et al. 2021

obm transplant

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The specification of anti-human leukocyte antigen (HLA) antibodies is an important task for patients awaiting kidney allografts. Especially the patients immunized in previous transplantations, transfusions, or pregnancies must be carefully observed, since grafting patients with HLA antigens/phenotypes recognized by their pre-formed antibodies are the main cause of harmful hyperacute and acute rejection. The complement-dependent lymphocytotoxicity-based de facto (physical) crossmatching (CDC-CM) has thus been implemented as the last diagnostic obstacle before kidney allografting. Here, an assay is performed by incubating the donors’ lymphocytes with the sera of the prospective recipients, and a negative outcome was desired for eligibility of the underlying organ allocation. Furthermore, valid antibody specification has to be performed at least quarterly for each patient on the kidney waiting list, as defined by certain guidelines, for example, the Eurotransplant guidelines. Based on the exclusion of these specificities, also referred to as virtual crossmatching, certain donors are a priori listed as unacceptable for these recipients. In this case report, we showed that defining unacceptable antigens may be difficult if the recipients’ antibodies are allele-specific after being generated in the patient who is expressing the HLA-class II antigen DQ6 and also developing antibodies against this antigen. Low resolution (two-digit) typing is used before kidney allografting. Thus, these antibodies are generally not definable, as donors and recipients share the same antigen (allelic group). Here, we demonstrate the diagnostic approaches required to exclude inadequate kidney donors for a patient exhibiting antibodies only against the HLA-DQB1*06:04 allelic variant and not against the common phenotype HLA-DQ6. In practice, the patient’s HLA-class II high resolution (four-digit) typing, as well as his antibody specification at the highest (single antigen) resolution, are included. Furthermore, we critically discuss, according to the Eurotransplant guidelines, the missing possibility to declare own HLA-antigens unacceptable, which may be very helpful for recipients who exhibit allele-specific antibodies.

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“…Rees et al (14) observed that if renal recipients and their donors were matched for HLA-B, more than 60% were also matched for HLA-C, and conversely, if there was a mismatch for HLA-B, 85% of the recipient/donor pairs were also mismatched for HLA-C. To exclude the possibility that an HLA-C mismatch effect could be masked by the consequence of an HLA-B mismatch, we based our current analysis on transplants that were matched for HLA-B, thereby increasing the likelihood of revealing a true impact of HLA-C incompatibility in kidney transplantation. Moreover, we used molecular methods for the accurate determination of HLA-C specificities in donor and recipient because serological HLA-C typing has been shown to be afflicted with a high technical error rate (11).…”

Section: Discussionmentioning

confidence: 99%

“…A further aspect to be taken into consideration is the strong linkage disequilibrium between HLA-C and HLA-B (13). As a consequence, an HLA-C mismatch is often associated with an HLA-B mismatch (14). It is therefore conceivable that a potential (presumably weak) influence of HLA-C mismatch may be masked by the (stronger) adverse effect of HLA-B mismatch on allograft survival.…”

mentioning

confidence: 99%

Deleterious Impact of Mismatching for Human Leukocyte Antigen-C in Presensitized Recipients of Kidney Transplants

et al. 2011

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HLA-C mismatch has a substantial deleterious effect on graft survival in presensitized kidney recipients. Our study points out the need for investigations directed at identifying donor-specific HLA-C antibodies and evaluating their relevance in transplantation. In view of the fact that current assays for determining HLA-C specific antibodies are hampered by additional detection of clinically irrelevant antibodies, matching for HLA-C may provide a reasonable approach to improve transplant outcomes in presensitized kidney transplant recipients.

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HLA-A, B, C, DRB1, DQB1 matching heterogeneity in ‘favourably matched’ kidney recipients

Cited by 9 publications

References 25 publications

HLA mismatches influence lung transplant recipient survival, bronchiolitis obliterans and rejection: Implications for donor lung allocation

HLA mismatches influence lung transplant recipient survival, bronchiolitis obliterans and rejection: Implications for donor lung allocation

Generation of Unexpected Allele-Specific Anti-HLA Antibodies after the Transplantation of a Fully-Matched Kidney Allograft and the Diagnostic Approaches Required for Excluding Harmful Effects after Subsequent Renal Regrafts

Deleterious Impact of Mismatching for Human Leukocyte Antigen-C in Presensitized Recipients of Kidney Transplants

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