Terasaki Festschrift 2014
Clinical Relevance of Pre- and Post-Transplant HLA antibodies, Donor-Specific and Non-Donor-Specific HLA Antibodies Detected
by ELISA in Renal Transplantation
Po-Chang Lee, M.D.,M.T.L.
Professor of SurgeryNational Cheng Kung University Hospital, TaiwanChairperson of the BoardTaiwan Organ Registry and Sharing Center
De novo Post-Transplant Antibody
0 <6M1yr 2 3 4 5 6 7 8yr
Lee PC, Terasaki PI, et al. Transplantation 2002; 74(8): 1192-1194
2. Dangerous
Late
Failure Early
Lee, PC, Terasaki, et al, Early antibodies Transplantation 2009;88:568-574
HLA Abs detected method and cost
• ELISA• LATM (Screening): US12• LAT (Identification): US60
• Luminex• LAB (single antigen bead
assay): US 558
Table 1. Patient characteristics HLA- (n= 162) HLA+ (n= 18) P-ValueAge (years) 40.9±13.0 45.7±10.6 0.134Sex (Male) 77 (48%) 13 (72%) 0.047*Source (Living) 75 (46%) 11 (61%) 0.233Donor Blood type
A 54 (33%) 6 (33%) 0.988B 41 (25%) 4 (22%) O 52 (32%) 6 (33%) AB 15 (9%) 2 (11%)
Receiver Blood type A 46 (28%) 5 (28%) 0.952B 35 (22%) 4 (22%) O 69 (43%) 7 (39%) AB 12 (32%) 2 (11%)
CDC XM 154 (95%) 15 (83%) <0.001*DTT CDC XM 8 (5%) 3 (17%)
HBV (+) 19 (12%) 1 (6%) 0.698HCV (+) 18 (11%) 2 (11%) 1.000Patient survival follow up 33.2±21.5 18.9±13.3 <0.001*Graft survival follow up 31.9±21.5 18.8±13.3 0.001*
Figure 1. Pre- Transplant HLA Antibodies being Detected
DSA vs NDSA vs HLA Ab(- )DSA vs HLA Ab
(- )NDSA vs HLA Ab
(- )
OD=2 P=0.111 (N=6 vs 12 vs 162) 0.208 0.065*
OD=4 P=0.015* (N=5 vs 13 vs 162) 0.615 0.0005*
OD=6 P=0.032* (N=3 vs 15 vs 162) 0.677 0.010*
OD=8 P=0.093 (N=1 vs 17 vs 162) 0.851 0.029*
Table 2. Comparison of Graft Survival According to Pre-transplant HLA
Antibodies, DSA and NDSA being Detected
Figure 2. Post-transplant HLA Antibodies being Detected
DSA vs NDSA vs HLA Ab
(- )DSA vs HLA Ab
(- )NDSA vs HLA Ab
(- )
OD=2 P=0.064 (N=13 vs 19 vs 148) 0.047* 0.290
OD=4 P=0.186 (N=9 vs 23 vs 148) 0.084 0.717
OD=6 P=0.015 (N=4 vs 28 vs 148) 0.006* 0.599
OD=8 P=0.912 (N=1 vs 31 vs 148) 0.124 0.895
Table 3. Comparison of Graft Survival According to Post-transplant HLA Antibodies, DSA and NDSA being Detected
Figure 3. Post-transplant HLA Antibodies to Class I or Class II being Detected
Pre- / Post- transplant 3 years GS 5 years GS P-Value
+ /+ (N=14) vs + /- (N=4) 65.6% vs 100% 65.6% vs 100% 0.362
+ /+ (N=14) vs - /+(N=18)
65.6% vs 100% 65.6% vs 100% 0.043*
+ /+ (N=14) vs - /-(N=144)
65.6% vs 92.0% 65.6% vs 85.5% 0.015*
+ /- (N=4) vs - /+(N=18)
100% vs 100% 100% vs 100% 1.0
+ /- (N=4) vs - /-(N=144)
100% vs 92.0% 100% vs 85.5% 0.656
- /+ (N=18) vs - /-(N=144)
100% vs 92.0% 100% vs 85.5% 0.966
Table 4. Comparison of Graft Survival According to Pre-transplant and Post-transplant HLA Antibodies being Detected
Figure 4. Comparison of Graft Survival According to Pre- transplant CDC-XM and DTT CDC-XM
Take Home Message1. There was a significant difference in graft survival
between patients with pre-transplant NDSA and those without HLA antibodies (P=0.0005) .
2. There was a significant difference in graft survival between patients with post-transplant DSA and those without HLA antibodies (P=0.006) .
3. For patients who had persistent pre- and post-transplant HLA antibodies, worst long term survival could be found.
4, We believe HLA antibody analysis by ELISA is still very useful for transplantation.
National Cheng Kung University Hospital, Tainan, Taiwan
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