Predictive value of mixed antigen screen beads in pre-transplant assessment of HLA immunization in solid organ transplant recipients

Autor: Jérémy Siemowski, Sophie Caillat-Zucman, Jean-Luc Taupin, Renaud Snanoudj, Christophe Legendre, Pierre Galichon, Michel Delahousse, Elizabeth Amankwa, Marie Matignon, Nadia Arzouk, Vissal-David Kheav
Rok vydání: 2020
Předmět:
Zdroj: Clinical transplantationREFERENCES. 34(9)
ISSN: 1399-0012
Popis: Pre-transplant serum screening of anti-HLA antibodies is recommended for solid organ transplantations. Many laboratories use the less expensive bead-based screening assay as the main technique and, if positive, turn to single-antigen beads (SAB). We studied the correlations between these two immunoassays. We re-analyzed the raw data of the two assays in 3030 first organ transplant recipients, explored with the two tests. We performed a ROC curve analysis of the screening ratio to predict a positive SAB assay. The AUC were 0.72 and 0.64 for class I and class II. The optimal thresholds of screening ratios were 3.28 (class I) and 2.11 (class II). Whatever the class, the negative predictive value was low, around 40%, with 36% of discordant sera, as defined by negative screening and positive SAB. Testing class I discordant sera on acid-treated SAB showed that 54% of antibodies reacted against denatured HLA molecules. However, these screening-negative sera may contain donor-specific antibodies in 13.9% and 28.7% of cases for class I and class II, respectively, involved in antibody-mediated rejection with the same frequency as non-discordant sera. Given the low predictive value of screening, both assays should be performed at least once on the same serum before transplantation.
Databáze: OpenAIRE
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