Emerging role of donor-specific anti-human leukocyte antigen antibody determination for clinical management after solid organ transplantation

Adriana Zeevi, John G. Lunz, Ron Shapiro, Parmjeet Randhawa, George Mazariegos, Steven Webber, Alin Girnita

Research output: Contribution to journalArticlepeer-review

41 Scopus citations

Abstract

Preformed and de novo donor-specific HLA antibodies (DSA) have been associated with allograft dysfunction and failure. The application of solid-phase methods have increased the sensitivity and specificity of antibody detection; however the clinical significance of these DSA is under evaluation. In the present study, we summarize six cases (four renal transplant recipients, one multivisceral recipient, and one heart-and-lung transplant recipient) to illustrate the role of the histocompatibility laboratory in providing the most comprehensive workup to assess the risk of graft dysfunction associated with antibody-mediated rejection (AMR). These cases illustrate the potential risk assessment for AMR in various situations: (1) in patients exhibiting low levels of DSA pretransplantation; (2) protocol immunosuppression minimization during stepwise weaning; and (3) desensitization protocols. Furthermore, increased sensitivity of DSA determination is indicated for the interpretation of focal C4d and its clinical significance. The clinical relevance of monitoring for circulating DSA with solid-phase single-antigen assays is also discussed. These cases exemplify the rationale for all patients to be monitored for DSA post-transplantation, with the frequency adjusted based on the individual risk for AMR.

Original languageEnglish
Pages (from-to)645-650
Number of pages6
JournalHuman Immunology
Volume70
Issue number8
DOIs
StatePublished - Aug 2009
Externally publishedYes

Keywords

  • Antibody-mediated rejection
  • C4d
  • Donor-specific antibody
  • HLA antibody
  • Solid organ transplantation

Fingerprint

Dive into the research topics of 'Emerging role of donor-specific anti-human leukocyte antigen antibody determination for clinical management after solid organ transplantation'. Together they form a unique fingerprint.

Cite this