BACKGROUND: Patients with human leukocyte antigen antibodies constitute a significantly disadvantaged population among those awaiting renal transplantation. We speculated that more understanding of the patients' antibody makeup would allow a more "immunologic" evaluation of crossmatch data, facilitate the use of virtual crossmatch (XM), and lead to more transplantability of these patients. METHODS: We retrospectively compared the transplantability and transplant outcome of two consecutive patient populations transplanted in our center. Group I (n=374) was evaluated using solid-phase base testing for determination of percentage panel reactive antibody ("PRA screen") with limited antibody identification testing. Group II (n=333) was tested in a more comprehensive manner with major emphasis on antibody identification, antibody strength assignment, and the use of pronase for crossmatch. RESULTS: Given this approach, 49% (166/333) of the transplanted patients in group II were sensitized compared with 40% (150/374) of the recipients in group I; P=0.012. Transplant outcome at 1-year posttransplant was similar in both groups. CONCLUSIONS: We conclude that comprehensive evaluation of human leukocyte antigen sensitization and application of immunologic in analyzing compatibility between donor and recipient can increase the transplantability of sensitized patients while maintaining similar outcome. Our approach is in line with United Network for Organ Sharing new guidelines for calculated panel reactive antibody and virtual XM analysis. We hope this report will prompt additional transplant programs to consider how they will use the new United Network for Organ Sharing algorithms.
BACKGROUND:Patients with human leukocyte antigen antibodies constitute a significantly disadvantaged population among those awaiting renal transplantation. We speculated that more understanding of the patients' antibody makeup would allow a more "immunologic" evaluation of crossmatch data, facilitate the use of virtual crossmatch (XM), and lead to more transplantability of these patients. METHODS: We retrospectively compared the transplantability and transplant outcome of two consecutive patient populations transplanted in our center. Group I (n=374) was evaluated using solid-phase base testing for determination of percentage panel reactive antibody ("PRA screen") with limited antibody identification testing. Group II (n=333) was tested in a more comprehensive manner with major emphasis on antibody identification, antibody strength assignment, and the use of pronase for crossmatch. RESULTS: Given this approach, 49% (166/333) of the transplanted patients in group II were sensitized compared with 40% (150/374) of the recipients in group I; P=0.012. Transplant outcome at 1-year posttransplant was similar in both groups. CONCLUSIONS: We conclude that comprehensive evaluation of human leukocyte antigen sensitization and application of immunologic in analyzing compatibility between donor and recipient can increase the transplantability of sensitized patients while maintaining similar outcome. Our approach is in line with United Network for Organ Sharing new guidelines for calculated panel reactive antibody and virtual XM analysis. We hope this report will prompt additional transplant programs to consider how they will use the new United Network for Organ Sharing algorithms.
Authors: Elena Rodica Vasilescu; Eric K Ho; Adriana I Colovai; George Vlad; Aurica Foca-Rodi; Glen S Markowitz; Vivette D'Agati; Mark A Hardy; Lloyd E Ratner; Nicole Suciu-Foca Journal: Hum Immunol Date: 2006-05-23 Impact factor: 2.850
Authors: R A Bray; J D L Nolen; C Larsen; T Pearson; K A Newell; K Kokko; A Guasch; P Tso; J B Mendel; H M Gebel Journal: Am J Transplant Date: 2006-08-25 Impact factor: 8.086
Authors: Martin Karpinski; David Rush; John Jeffery; Markus Exner; Heinz Regele; Silvia Dancea; Denise Pochinco; Patricia Birk; Peter Nickerson Journal: J Am Soc Nephrol Date: 2001-12 Impact factor: 10.121
Authors: Reyna S Goodman; Craig J Taylor; Cheryl M O'Rourke; Andrew Lynch; J Andrew Bradley; Tim Key Journal: Transplantation Date: 2006-05-15 Impact factor: 4.939
Authors: Aliki G Iniotaki-Theodoraki; John N Boletis; George Ch Trigas; Helen G Kalogeropoulou; Alkiviadis G Kostakis; Catherine G Stavropoulos-Giokas Journal: Transplantation Date: 2003-05-15 Impact factor: 4.939
Authors: A R Tambur; D S Ramon; D B Kaufman; J Friedewald; X Luo; B Ho; A Skaro; J Caicedo; D Ladner; T Baker; J Fryer; L Gallon; J Miller; M M Abecassis; J Leventhal Journal: Am J Transplant Date: 2009-06-26 Impact factor: 8.086