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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Clin+Kidney+J
2013 ; 6
(3
): 283-6
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Impact of sensitivity of human leucocyte antigen antibody detection by Luminex
technology on graft loss at 1 year
#MMPMID26064487
Szatmary P
; Jones J
; Hammad A
; Middleton D
Clin Kidney J
2013[Jun]; 6
(3
): 283-6
PMID26064487
show ga
BACKGROUND: The clinical relevance of the detection of human leucocyte antigen
(HLA) antibodies in sera of renal transplant recipients by highly sensitive
methods such as Luminex alone is uncertain and a matter of debate. The choice of
output thresholds affects antibody detection and thus organ allocation, yet there
are no internationally agreed threshold levels. This study aims at evaluating our
current practice of using an MFI threshold of 1000 in antibody detection.
METHODS: We carried out a case-control study by looking at 761 renal transplant
recipients at one unit between 2000 and 2010. Of these, there were 93 cases of
graft loss within 1 year and stored serum samples of 40 cases were available for
testing. Controls were selected (graft function >2 years) and individually
matched according to age, sex, number of transplants and date of transplant. All
40 cases and 40 controls had negative crossmatch by complement-dependent
cytotoxicity (CDC) at the time of transplant, and pre-transplant sera were
re-analysed for the presence of detectable HLA and donor-specific antibodies
(DSAs) using Luminex screen and single-antigen beads and MFI threshold values of
1000, 2000 and 4000. RESULTS: In nearly 48% of cases with graft loss within a
year, HLA antibodies were detectable by Luminex when using a 1000 MFI threshold.
This was 25% greater than in controls (P = 0.017). There was also a 15% increase
in detected DSAs; however, statistical significance depends on the inclusion or
exclusion of one specific case. Using MFI thresholds of 2000 and 4000, no DSAs
were found in any long-term surviving grafts. CONCLUSIONS: Selection of
appropriate MFI cut-off values influences the detection of DSAs and, thus, organ
allocation. Using a threshold of 1000 led to the detection of DSAs in 5% of
long-term graft survivors in our population and should be considered too
sensitive. Using a detection threshold of 2000 is sufficiently sensitive and
leads to clinically relevant detection of DSA.