J Korean Soc Transplant.  2008 Jun;22(1):85-91.

Comparison of Anti-HLA Detecting Methods; Cytotoxicity, Flow Cytometric Crossmatch, Multiple Antigen-ELISA, Single Antigen-ELISA

• Oh EJ
• Lee J
• Yang CW
• Moon IS
• Park YJ
• Han K

Abstract

PURPOSE: Identification of antibody specificity is difficult using a multiple antigen PRA (MA-PRA) assay. The purpose of this study was to determine the clinical impact of single antigen PRA (SA-PRA) ELISA assay on the transplant outcome and to analyze the clinical significance of SA-PRA compared with CDC-AHG, flow cytometric crossmatch (FCXM) and MA-PRA.
METHODS
A total of 151 kidney transplanted patients were tested for the presence of HLA antibodies in the pre- and posttransplant period. The HLA specificities were classified as donor-specific antibodies (DSA) including donor private antigen specific (DS-HLA) or donor public antigen specific (DS-cross reactive group (CREG)), and nondonor specific HLA antibodies.
RESULTS
Of the 151 recipients, 28 patients experienced acute rejection episodes (ARE). The pretransplant CDC-AHG, FCXM and MA-PRA tests were positive in 2, 8 and 18 patients, respectively and the concordance between FCXM and MA-PRA was 89.4% (135/151). Of the 47 sera which were tested with both MA-PRA and SA-PRA, 4 sera were SA-PRA positive and MA-PRA negative. The HLA specificities which were not determined with MA-PRA were detected with SA-PRA test. The patients with DSA showed higher incidence of ARE (7/12, 58% vs. 21/139, 15%; P<0.001) and lower glomerular filtration rate (GFR) at 6 posttransplant months (54.9+/-10.2 vs. 66.2+/-19.3; P=0.023) than the patients without DSA. The patients with ARE had higher incidence of posttransplant DS-HLA (6 (21%) vs. 0 (0%); P<0.001), DS- CREG (7 (25%) vs. 0 (0%); P<0.001), de novo HLA antibody (6 (21%) vs. 0 (0%); P<0.001) than the patients without ARE.
CONCLUSION
This study suggests that analysis of HLA specificities using the SA-PRA may be useful as a supportive crossmatch test or as a monitoring test after transplantation for early detection of patients at risk of poor clinical outcome.

Keyword

Transplantation; Donor-specific HLA antibody; Panel reactive antibody (PRA); Flow cytometric crossmatch; Single antigen PRA

MeSH Terms

Antibodies
Antibody Specificity
Enzyme-Linked Immunosorbent Assay
Glomerular Filtration Rate
Humans
Incidence
Kidney
Rejection (Psychology)
Tissue Donors
Transplants
Antibodies