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Human leukocyte antigen typing and crossmatch: A comprehensive review

Renal transplantation remains the best option for patients suffering from end stage renal disease (ESRD). Given the worldwide shortage of organs and growing population of patients with ESRD, those waitlisted for a transplant is ever expanding. Contemporary crossmatch methods and human leukocyte anti...

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Autores principales: Althaf, Mohammed Mahdi, El Kossi, Mohsen, Jin, Jon Kim, Sharma, Ajay, Halawa, Ahmed Mostafa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5743871/
https://www.ncbi.nlm.nih.gov/pubmed/29312863
http://dx.doi.org/10.5500/wjt.v7.i6.339
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author Althaf, Mohammed Mahdi
El Kossi, Mohsen
Jin, Jon Kim
Sharma, Ajay
Halawa, Ahmed Mostafa
author_facet Althaf, Mohammed Mahdi
El Kossi, Mohsen
Jin, Jon Kim
Sharma, Ajay
Halawa, Ahmed Mostafa
author_sort Althaf, Mohammed Mahdi
collection PubMed
description Renal transplantation remains the best option for patients suffering from end stage renal disease (ESRD). Given the worldwide shortage of organs and growing population of patients with ESRD, those waitlisted for a transplant is ever expanding. Contemporary crossmatch methods and human leukocyte antigen (HLA) typing play a pivotal role in improving organ allocation and afford better matches to recipients. Understanding crossmatch as well as HLA typing for renal transplantation and applying it in clinical practice is the key step to achieve a successful outcome. Interpretation of crossmatch results can be quite challenging where clinicians have not had formal training in applied transplant immunology. This review aims to provide a worked example using a clinical vignette. Furthermore, each technique is discussed in detail with its pros and cons. The index case is that of a young male with ESRD secondary to Lupus nephritis. He is offered a deceased donor kidney with a 1-0-0 mismatch. His complement dependent cytotoxicity (CDC) crossmatch reported positive for B lymphocyte, but flow cytometry crossmatch (FCXM) was reported negative for both B and T lymphocytes. Luminex-SAB (single antigen bead) did not identify any donor specific antibodies (DSA). He never had a blood transfusion. The positive CDC-crossmatch result is not concordant with DSA status. These implausible results are due to underlying lupus erythematosus, leading to false-positive B-lymphocyte crossmatch as a result of binding immune complexes to Fc-receptors. False positive report of CDC crossmatch can be caused by the underlying autoimmune diseases such as lupus erythematosus, that may lead to inadvertent refusal of adequate kidney grafts. Detailed study of DSA by molecular technique would prevent wrong exclusion of such donors. Based on these investigations this patient is deemed to have “standard immunological risk” for renal transplantation.
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spelling pubmed-57438712018-01-08 Human leukocyte antigen typing and crossmatch: A comprehensive review Althaf, Mohammed Mahdi El Kossi, Mohsen Jin, Jon Kim Sharma, Ajay Halawa, Ahmed Mostafa World J Transplant Minireviews Renal transplantation remains the best option for patients suffering from end stage renal disease (ESRD). Given the worldwide shortage of organs and growing population of patients with ESRD, those waitlisted for a transplant is ever expanding. Contemporary crossmatch methods and human leukocyte antigen (HLA) typing play a pivotal role in improving organ allocation and afford better matches to recipients. Understanding crossmatch as well as HLA typing for renal transplantation and applying it in clinical practice is the key step to achieve a successful outcome. Interpretation of crossmatch results can be quite challenging where clinicians have not had formal training in applied transplant immunology. This review aims to provide a worked example using a clinical vignette. Furthermore, each technique is discussed in detail with its pros and cons. The index case is that of a young male with ESRD secondary to Lupus nephritis. He is offered a deceased donor kidney with a 1-0-0 mismatch. His complement dependent cytotoxicity (CDC) crossmatch reported positive for B lymphocyte, but flow cytometry crossmatch (FCXM) was reported negative for both B and T lymphocytes. Luminex-SAB (single antigen bead) did not identify any donor specific antibodies (DSA). He never had a blood transfusion. The positive CDC-crossmatch result is not concordant with DSA status. These implausible results are due to underlying lupus erythematosus, leading to false-positive B-lymphocyte crossmatch as a result of binding immune complexes to Fc-receptors. False positive report of CDC crossmatch can be caused by the underlying autoimmune diseases such as lupus erythematosus, that may lead to inadvertent refusal of adequate kidney grafts. Detailed study of DSA by molecular technique would prevent wrong exclusion of such donors. Based on these investigations this patient is deemed to have “standard immunological risk” for renal transplantation. Baishideng Publishing Group Inc 2017-12-24 2017-12-24 /pmc/articles/PMC5743871/ /pubmed/29312863 http://dx.doi.org/10.5500/wjt.v7.i6.339 Text en ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Minireviews
Althaf, Mohammed Mahdi
El Kossi, Mohsen
Jin, Jon Kim
Sharma, Ajay
Halawa, Ahmed Mostafa
Human leukocyte antigen typing and crossmatch: A comprehensive review
title Human leukocyte antigen typing and crossmatch: A comprehensive review
title_full Human leukocyte antigen typing and crossmatch: A comprehensive review
title_fullStr Human leukocyte antigen typing and crossmatch: A comprehensive review
title_full_unstemmed Human leukocyte antigen typing and crossmatch: A comprehensive review
title_short Human leukocyte antigen typing and crossmatch: A comprehensive review
title_sort human leukocyte antigen typing and crossmatch: a comprehensive review
topic Minireviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5743871/
https://www.ncbi.nlm.nih.gov/pubmed/29312863
http://dx.doi.org/10.5500/wjt.v7.i6.339
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