HLA sensitisation: can it be prevented?

Rees, Lesley; Kim, Jon Jin

doi:10.1007/s00467-014-2868-6

Cited by 52 publications

(33 citation statements)

References 80 publications

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“…Patients who did not achieve an adequate response to HLA‐selected platelets were tested for HPA antibodies using an in‐house Platelet Immunofluorescence test and a monoclononal antibody immobilised platelet antigen technique . The antibody alloimmunisation status of patients was expressed as cRF%, as previously described . The cRF% was used to try and standardise the calculation of patient HLA reactivity as the cell panels differed between the antibody testing techniques and within each technique over the 4‐year period of the retrospective study.…”

Section: Methodsmentioning

confidence: 99%

“…19 The antibody alloimmunisation status of patients was expressed as cRF%, as previously described. 20 The cRF% was used to try and standardise the calculation of patient HLA reactivity as the cell panels differed between the antibody testing techniques and within each technique over the 4-year period of the retrospective study. Highly sensitised patients with a cRF of >85% were categorised as having a high cRF and patients with a cRF <85% were categorised as low cRF.…”

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confidence: 99%

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Impact of Human Leucocyte Antigen epitope matched platelet transfusions in alloimmunised aplastic anaemia patients

Kallon

Navarrete

Sage

et al. 2019

Transfusion Medicine

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Summary Aims/Objectives To explore the impact of Human Leucocyte Antigen (HLA)‐A and B epitope‐matched platelets on the outcome of platelet transfusions in alloimmunised patients with aplastic anaemia (AA). The relevance of HLA‐C epitope mismatches was also investigated. Background Patients who become immunologically refractory (IR) to random platelet transfusions can experience an adequate rise in platelet count through the provision of HLA‐compatible platelets using an antigen‐matching algorithm. This approach has been shown to be effective in patients with a low calculated reaction frequency, but it is not always successful in highly sensitised patients. The use of HLA epitopes‐selected platelets has been suggested as an alternative to the antigen matching approach. Methods The effect of HLA epitope matching (both Eplets and Triplets) on the outcome of platelet transfusion was analysed in 37 highly immunised AA patients previously transfused with HLA‐A and B antigen‐matched platelets. Epitope matching was determined using the HLAMatchmaker programme. The outcome of the transfusions was assessed by the platelet count increments (PCIs) obtained 1 and 24 hours post‐transfusions. Results HLA‐A and B epitope matching was equivalent to HLA antigen matching in raising platelet counts. There was no significant difference in PCI when HLA‐C epitope mismatches were considered. In addition, transfusions with fewer than two antigen mismatches resulted in significantly higher PCIs compared to transfusions with more than two antigen mismatches. Conclusions HLA epitope‐matched platelet provision may represent a clinically effective transfusion strategy for patients IR to random platelet transfusions. Further prospective studies are required.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Impact of Human Leucocyte Antigen epitope matched platelet transfusions in alloimmunised aplastic anaemia patients

Kallon

Navarrete

Sage

et al. 2019

Transfusion Medicine

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“…While transfusion and blood prime avoidance to prevent sensitization/allo‐immunization is optimal, if infants are transfused during HD, transfusion volume should be accounted for in ultrafiltration goals and post‐transfusion hematocrit/hemoglobin should be obtained. It is important to remember that the risk of sensitization is increased in children with previous sensitization events such as failed transplants and recurrent blood transfusions . A study showed even using washed leucodepleted red cells did not reduce the risk of sensitization in children with chronic kidney disease .…”

Section: Part 2 Interpretative Reviewmentioning

confidence: 99%

Hemodialysis in neonates and infants: A systematic review

Raina

Vijayaraghavan

Kapur

et al. 2017

Seminars in Dialysis

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Hemodialysis (HD) in neonates and infants poses unique challenges due to high risks of mortality attributable to obligatory small blood flow volumes. Although HD is often necessary in neonates, its effectiveness and feasibility are poorly understood. The aim of this review is to describe in detail the few studies reporting on HD in neonates and infants (<12 months old) and then dissertate more broadly on the subject with an emphasis on recent innovations with potential to overcome traditional barriers for effective HD in this population. We detail the clinical characteristics, outcomes, technical considerations, maintenance and complications associated with HD, and provide guidance for addressing challenges associated with HD in this population.

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“…8 Subsequently, this shared protocol was discarded because of the high risk of anti-HLA antibody sensitization and infection. 9 A recent metaanalysis reported that higher rates of anti-HLA antibodies were found in patients with a previous transfusion compared with those without. 10 In pregnancy-sensitized patients, anti-HLA antibodies directed to paternal HLA mismatches were found in 15% to 30% of women, 11 and the immunogenicity of mismatches may be due to the HLA phenotype of the wife and of the husband.…”

Section: Introductionmentioning

confidence: 99%

“…15 It has been suggested that anti-HLA antibodies in patients without a history of known sensitization events were developed in response to cross-reactive epitopes on microorganisms, allergens, and ingested proteins. 9,15,16 The aim of our study was to present the rate of positivity of anti-HLA antibody considering the effect of a single sensitizing event in kidney transplant candidates in the Campania Region (Southern Italy).…”

Section: Introductionmentioning

confidence: 99%

Untitled

Resse¹,

Paolillo²,

Minucci³

et al. 2018

Exp Clin Transplant

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Objectives: Human leukocyte antigen alloimmunization is caused by exposure to HLA antigens through transfusion, pregnancy, or transplant. Our study objective was to present the rate of positivity of anti-HLA antibody considering the effects of a single sensitization event in kidney transplant candidates at our center. Materials and Methods: Our study reviewed 606 kidney transplant candidates. Patient sera were analyzed using Luminex xMAP technology. Panel reactive antibody positivity rates and antibody strengths in patients were analyzed according to a single sensitization event. Results: Our findings showed 246 patients (40.6%) with a panel reactive antibody > 0, of which 97 (39.4%) were sensitized from a single event, 119 (48.4%) were sensitized by multiple events, and 30 (12.2%) had no known sensitizing event. Considering patients sensitized by a single event with a panel reactive antibody > 0, we found that 25.8% had received transplant only, 49.5% had previous pregnancy only, and 24.7% had received transfusion only. The strength of antibodies was significantly higher in patients with previous transplant procedures than in those with transfusion for HLA-A (P < .01), HLA-B (P < .05), HLA-C (P < .05), HLA-DR (P < .001), HLA-DQ (P < .05), and HLA-DP (P < .05). Similarly, we observed significantly higher median fluorescence intensity values for HLA-A, -DR, -DQ, and -DP loci in patients with a previous transplant procedure versus preg nancy. The strength of antibodies against HLA-DR was significantly higher in patients with a previous pregnancy compared with those with transfusion (P < .01). Conclusions: This study documents the profile of HLA alloimmunization in kidney transplant candidates. In particular, transplant procedures appear to have a greater immunologic impact, followed by pregnancy and transfusion. Our data confirm and are in accordance with those of several studies in which the sensitization events were associated with higher prevalence of anti-HLA antibodies.

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HLA sensitisation: can it be prevented?

Cited by 52 publications

References 80 publications

Impact of Human Leucocyte Antigen epitope matched platelet transfusions in alloimmunised aplastic anaemia patients

Impact of Human Leucocyte Antigen epitope matched platelet transfusions in alloimmunised aplastic anaemia patients

Hemodialysis in neonates and infants: A systematic review

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