1. Impact of allele-specific anti-human leukocyte antigen class I antibodies on organ allocation.
- Author
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Yeung MY, Murakami N, Kafetzi ML, Simmons DP, Wood I, Macaskill P, Towle M, DellaGatta J, Stevens J, Comeau E, Baronas J, Mohsin N, Chen M, Lee JH, Lane WJ, Milford EL, and Guleria I
- Subjects
- Humans, Alleles, Histocompatibility Testing methods, HLA Antigens genetics, Antigens, Isoantibodies, Histocompatibility Antigens Class I genetics
- Abstract
Technological advances in the field of histocompatibility have allowed us to define anti-human leukocyte antigen (HLA) antibody specificity at the allelic level. However, how allele-specific antibodies affect organ allocation is poorly studied. We examined allelic specificities of class I HLA antibodies in 6726 consecutive serum samples from 2953 transplant candidates and evaluated their impact on the corresponding crossmatch and organ allocation. Out of 17 class I HLA antigens represented by >1 allele in the LABScreen single antigen bead assay, 12 had potential allele-specific reactivity. Taking advantage of our unbiased cohort of deceased donor-candidate testing (123,135 complement-dependent cytotoxicity crossmatches between 2014 and 2017), we estimated that the presence of allele-specific antibody detected using a single antigen bead assay (median fluorescence intensity, >3000) against only the rare allele was a poor predictor of a positive complement-dependent cytotoxicity crossmatch, with a positive predictive value of 0% to 7%, compared with 52.5% in allele-concordant class I HLA antibodies against A or B locus antigens. Further, we confirmed allele-specific reactivity using flow crossmatch in 3 scenarios: A11:01/A11:02, A68:01/A68:02, and B44:02/B44:03. Our results suggest that allele-specific antibodies may unnecessarily exclude transplant candidates (up to 10%) from organ offers by overcalling unacceptable antigens; incorporation of selective reactivity pattern in allocation may promote precision matching and more equitable allocation., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Melissa Yeung reports a relationship with One Lambda Inc that includes: consulting or advisory. Mike Chen reports a relationship with One Lambda Inc that includes: employment. Jar-How Lee reports a relationship with One Lambda Inc that includes: employment., (Copyright © 2023 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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