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

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• 作者：Nancy L. Reinsmoen ; PhD^a ; ^{reinsmoenn@cshs.org" class="auth_mail" title="E-mail the corresponding author} ; Jignesh Patel ; MD ; PhD^b ; James Mirocha ; MS^c ; Chih-hung Lai ; PhD^a ; Mehrnoush Naim ; BS^a ; Geraldine Ong ; BS^a ; Qi Wang ; MS^a ; Xiaohai Zhang ; PhD^a ; Frank Liou ; BS^b ; Zhe Yu ; MD ; MPH^b ; Jon Kobashigawa ; MD^b
• 关键词：heart transplant ; C1q ; solid phase antibody testing ; CDC ; CPRA ; unacceptable antigen
• 刊名：Journal of Heart and Lung Transplantation
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：35
• 期：2
• 页码：165-172
• 全文大小：334 K

文摘

The virtual crossmatch relies on the assignment of unacceptable antigens (UAs) to identify compatible donors. The purpose of our study was to identify an algorithm for assignment of UAs such that a negative complement-dependent cytotoxicity (CDC) crossmatch and concomitant negative or weakly positive flow cytometric crossmatch (FXM) are obtained.

Methods

We used 4 antibody methods: (1) Luminex single antigen (LSA), (2) LSA with a 1:8 serum dilution, (3) C1q LSA, and (4) CDC panel. The UAs were prioritized in the following order: (1) all C1q+/CDC+, (2) LSA 1:8 >7,500 median fluorescence intensity, and (3) LSA >10,000 median fluorescence intensity.

Results

Of 295 heart transplants that were performed at our center, 69 (23%) recipients had detectable human leukocyte antigen specific antibody at the time of transplant. All donor specific antibodies (DSAs) were avoided for 44 of 69 (64%) (DSA−). There were 25 recipients who had DSA at the time of transplant: 12 (48%) had negative FXM (DSA+/FXM−), and 13 (52%) had positive T-cell and/or B-cell FXM (DSA+/FXM+). Lower freedom from antibody-mediated rejection was observed for the DSA+/FXM+ group compared with the DSA− group (p < 0.0001). DSA remained detectable after transplant in the sera of 14 recipients, and de novo DSA was detected in 32 recipients. Freedom from antibody-mediated rejection was comparable for both groups (p = 0.53) but was lower than the DSA− group (p < 0.0001). Survival was comparable for all groups at 1,200 days post-transplant.

Conclusions

Strategic prioritization of UA assignment has allowed transplantation of highly sensitized patients across the DSA barrier with survival rates comparable to DSA− heart transplant recipients.