Organ Procurement and Transplantation Network/United Network for Organ Sharing Histocompatibility Committee Collaborative Study to Evaluate Prediction of Crossmatch Results in Highly Sensitized Patients

Nikaein, Afzal; Cherikh, Wida S.; Nelson, Karen; Baker, Timothy S.; Leffell, Sue; Bow, Laurine; Crowe, Debbie; Connick, Ketra; Head, M. A.; Kamoun, Malek; Kimball, Pam; Klohe, Ellen; Noreen, Harriet; Rebellato, Lorita M.; Sell, Tom; Sullivan, Karen A.; Land, Geoffrey A.

doi:10.1097/tp.0b013e3181943c76

Cited by 40 publications

(28 citation statements)

References 21 publications

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“…Whenever possible, kidney transplantation should be performed in the absence of DSAs. Virtual cross-matching, recently promoted by the United Network for Organ Sharing, 29 consists of selecting potential donors without HLA specificities against a recipient's antibodies, predicting a negative CXM. The use of the virtual cross-matching permits expanding the geographic regions from which kidneys can be drawn and reduces waiting time and deaths on the waiting list.…”

Section: Discussionmentioning

confidence: 99%

Preexisting Donor-Specific HLA Antibodies Predict Outcome in Kidney Transplantation

Lefaucheur¹,

Loupy²,

Hill³

et al. 2010

Journal of the American Society of Nephrology

716

567

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The clinical importance of preexisting HLA antibodies at the time of transplantation, identified by contemporary techniques, is not well understood. We conducted an observational study analyzing the association between preexisting donor-specific HLA antibodies (HLA-DSA) and incidence of acute antibody-mediated rejection (AMR) and survival of patients and grafts among 402 consecutive deceaseddonor kidney transplant recipients. We detected HLA-DSA using Luminex single-antigen assays on the peak reactive and current sera. All patients had a negative lymphocytotoxic cross-match test on the day of transplantation. We found that 8-year graft survival was significantly worse (61%) among patients with preexisting HLA-DSA compared with both sensitized patients without HLA-DSA (93%) and nonsensitized patients (84%). Peak HLA-DSA Luminex mean fluorescence intensity (MFI) predicted AMR better than current HLA-DSA MFI (P ϭ 0.028). As MFI of the highest ranked HLA-DSA detected on peak serum increased, graft survival decreased and the relative risk for AMR increased: Patients with MFI Ͼ6000 had Ͼ100-fold higher risk for AMR than patients with MFI Ͻ465 (relative risk 113; 95% confidence interval 31 to 414). The presence of HLA-DSA did not associate with patient survival. In conclusion, the risk for both AMR and graft loss directly correlates with peak HLA-DSA strength. Quantification of HLA antibodies allows stratification of immunologic risk, which should help guide selection of acceptable grafts for sensitized patients.

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Section: Discussionmentioning

confidence: 99%

Preexisting Donor-Specific HLA Antibodies Predict Outcome in Kidney Transplantation

Lefaucheur¹,

Loupy²,

Hill³

et al. 2010

Journal of the American Society of Nephrology

716

567

View full text Add to dashboard Cite

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“…12 When this approach is used in lieu of an actual cell-based crossmatch, it is called a virtual crossmatch. 5,8,[13][14][15][16] The Organ Procurement and Transplantation Network administered by the United Network for Organ Sharing implemented a calculated panel-reactive antibody (CPRA) based on UA assignment and their frequency in the donor population to provide a more accountable measure of sensitization and to assign priority points for kidney organ allocation. Although not used for allocation of thoracic organs, the CPRA is used to assess the probability of an incompatible donor in the donor pool for thoracic organ candidates.…”

mentioning

confidence: 99%

Optimizing transplantation of sensitized heart candidates using 4 antibody detection assays to prioritize the assignment of unacceptable antigens

Reinsmoen

Patel²,

Mirocha

et al. 2016

The Journal of Heart and Lung Transplantation

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“…Virtual crossmatching is particularly challenging in the KPD setting because the majority of waitlisted patients are highly sensitized to HLA (10,11) and the results for cellbased crossmatches are often difficult to predict (12)(13)(14). Strategies that have been developed to improve virtual crossmatch accuracy for this population include utilizing a core laboratory (15), specifying thresholds for assigning unacceptable HLA types (13,16) and allowing centers to enter two sets of antigens, one representing the center's criteria for automatic refusal and another that includes antibodies that are not an automatic contraindication but could be a problem, particularly when there are several weak donor-specific antibodies (DSAs) (17).…”

Section: Introductionmentioning

confidence: 99%

Center-Defined Unacceptable HLA Antigens Facilitate Transplants for Sensitized Patients in a Multi-Center Kidney Exchange Program

Baxter‐Lowe

Cecka

Kamoun

et al. 2014

American Journal of Transplantation

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Multi‐center kidney paired donation (KPD) is an exciting new transplant option that has not yet approached its full potential. One barrier to progress is accurate virtual crossmatching for KPD waitlists with many highly sensitized patients. Virtual crossmatch results from a large multi‐center consortium, the National Kidney Registry (NKR), were analyzed to determine the effectiveness of flexible center‐specific criteria for virtual crossmatching. Approximately two‐thirds of the patients on the NKR waitlist are highly sensitized (>80% CPRA). These patients have antibodies against HLA‐A (63%), HLA‐B (66%), HLA‐C (41%), HLA‐DRB1 (60%), HLA‐DRB3/4/5 (18–22%), HLA‐DQB1 (54%) and HLA‐DPB1 (26%). With donors typed for these loci before activation, 91% of virtual crossmatches accurately predicted an acceptable cell‐based donor crossmatch. Failed virtual crossmatches were attributed to equivocal virtual crossmatches (46%), changes in HLA antibodies (21%), antibodies against HLA‐DQA (6%), transcription errors (6%), suspected non‐HLA antibodies (5%), allele‐specific antibodies (1%) and unknown causes (15%). Some failed crossmatches could be prevented by modifiable factors such as more frequent assessment of HLA antibodies, DQA1 typing of donors and auditing data entry. Importantly, when transplant centers have flexibility to define crossmatch criteria, it is currently feasible to use virtual crossmatching for highly sensitized patients to reliably predict acceptable cell‐based crossmatches.

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Organ Procurement and Transplantation Network/United Network for Organ Sharing Histocompatibility Committee Collaborative Study to Evaluate Prediction of Crossmatch Results in Highly Sensitized Patients

Abstract: The above results showed that with the advent of solid phase immunoassays, HLA antibodies can now be accurately detected resulting in prediction of crossmatch outcome. This should facilitate organ allocation and prevents shipment of organs to distant incompatible recipients.

Cited by 40 publications

References 21 publications

Preexisting Donor-Specific HLA Antibodies Predict Outcome in Kidney Transplantation

Preexisting Donor-Specific HLA Antibodies Predict Outcome in Kidney Transplantation

Optimizing transplantation of sensitized heart candidates using 4 antibody detection assays to prioritize the assignment of unacceptable antigens

Center-Defined Unacceptable HLA Antigens Facilitate Transplants for Sensitized Patients in a Multi-Center Kidney Exchange Program

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