Prediction of crossmatch outcome of highly sensitized patients by single and/or multiple antigen bead luminex assay.
BACKGROUND
We used a solid-phase assay to identify human leukocyte antigen (HLA) Class I and II specificities in highly reactive sera, and applied this information to predict crossmatch outcome with greater than 90% accuracy.


METHODS
Sera from 20 highly sensitized end-stage renal disease patients reactive to 70-100% of HLA Class I and II antigen panel were analyzed by single and/or multiple antigen flow microparticle bead assay using Luminex platform (Luminex assay). These sera contained antibodies directed against high frequency public HLA class I and/or II epitopes accounting for 70-100% of serum's total reactivity. More than 2,000 complement dependent cytotoxicity (CDC) and 200 flow crossmatches (FLXM) were performed using sera from these patients and deceased donor T and B lymphocytes.


RESULTS
Luminex serum analysis was able to correctly predict outcomes of 95% of T and B cell FLXM. In contrast, predictive values for the CDC T and B cell crossmatches by Luminex serum analysis were only 77% and 75%, respectively. The use of serum analysis in donor selection would have reduced the total number of required FLXM by more than 50%. The frequency of negative T cell FLXM was 56% when donors were selected randomly; however, if serum antibody analysis had been used to preselect the donors by excluding donors that were likely to be positive, the frequency of corresponding negative crossmatches would have increased up to 93%.


CONCLUSIONS
This approach to donor selection may allow wider geographic sharing of cadaver donor organs without actually performing the crossmatch.
Vaidya
Smita
S
Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA. svaidya@utmb.edu
Partlow
David
D
Susskind
Brian
B
Noor
Maryam
M
Barnes
Titus
T
Gugliuzza
Kristine
K
D000906:Antibodies / Q000097:blood; D001402:B-Lymphocytes / Q000276:immunology; D002102:Cadaver; D046148:Donor Selection / Q000379:methods*; D015395:Histocompatibility Antigens Class I / Q000032:analysis*; D000949:Histocompatibility Antigens Class II / Q000032:analysis*; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000276:immunology; D008863:Microspheres; D012189:Retrospective Studies; D044967:Serum / Q000276:immunology*; D013601:T-Lymphocytes / Q000276:immunology; D014019:Tissue Donors
D000906:Antibodies; D015395:Histocompatibility Antigens Class I; D000949:Histocompatibility Antigens Class II