J Korean Soc Transplant.  2017 Sep;31(3):150-155. 10.4285/jkstn.2017.31.3.150.

False-Positive T-Cell Cytotoxicity Crossmatch Results Due to Autoantibodies in Korean Network for Organ Sharing Crossmatch Tests

• Park H
• Lee BH
• Lim YM
• Han B
• Song EY
• Park MH

• KMID: 2392422
• DOI: http://doi.org/10.4285/jkstn.2017.31.3.150

Abstract

BACKGROUND
Basic National Institute of Health (NIH) and sensitive antihuman globulin (AHG) methods are widely used for T-cell complement-dependent cytotoxicity crossmatch (XM) tests. Whereas NIH-negative, AHG-positive (NIH⁻/AHG⁺) results are caused by weak antibodies, NIH⁺/AHG⁻ results are usually due to autoantibodies. We found that solid organ transplantation candidates with NIH⁺/AHG⁻ XM results are repeatedly excluded from allocation of deceased donor organs by the Korean Network for Organ Sharing (KONOS) allocation system. Here, we attempted to demonstrate that these patients do not have donor-specific HLA antibodies (DSAs).
METHODS
Sera showing NIH⁺/AHG⁻ results in the analysis of 1,668 KONOS T-cell XM tests were screened for panel reactive antibody (PRA) using a Luminex test. For screen-positive samples, antibody identification was conducted using a Luminex single antigen assay and the presence or absence of class I DSAs was determined. For positive controls, 42 KONOS XM tests showing probable true-positive (NIH⁻/AHG⁺ or NIH⁺/AHG⁺) results were reviewed for PRA results based on electronic medical records and the presence or absence of DSAs was determined.
RESULTS
NIH⁺/AHG⁻ results were observed in 1.3% (21/1,668) of KONOS XM tests analyzed. Most of these (18/21, 85.7%) were negative for PRA or DSAs. All probable true-positive cases were either positive for DSAs (24/42, 57.1%) or had high PRA (mean, 92% [range; 42%~100%]), complicating accurate identification of antibody specificities.
CONCLUSIONS
NIH⁺/AHG⁻ results are not rare (1.3%) in KONOS XM tests. Most of these results are not due to DSAs, and these patients should not be excluded from organ allocation.

Keyword

Complement-dependent cytotoxicity; HLA crossmatch; Autoantibodies; Organ transplantation

MeSH Terms

Antibodies
Antibody Specificity
Autoantibodies*
Electronic Health Records
Humans
Organ Transplantation
T-Lymphocytes*
Tissue Donors
Transplants
Antibodies
Autoantibodies

Figure

• 

  Fig. 1 Results of panel reactive antibody (PRA) and donor-specific antibody (DSA) in T-cell complement-dependent cytotoxicity crossmatch (T-CDC XM) positive cases. Abbreviations: NIH, National Institute of Health; AHG, antihuman globulin. aDSA of weak to moderate strength (median fluorescence intensity values of 2,806~6,645) on Luminex single antigen test, which is not expected to give positive T-CDC XM results; bDSA could not be defined on Luminex PRA identification test because of high PRA values (mean, 92% [range; 42%~100%]), complicating accurate identification of antibody specificities.

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