title: Clinical significance of anti-HLA antibodies detected by Luminex: enhancing the interpretation of CDC-BXM and important post-transplantation monitoring tools.
abstract: B-cell crossmatch (BXM) was originally introduced to increase the sensitivity to detect anti-HLA antibodies of conventional CDC crossmatch in renal transplantation. Newer techniques such as Luminex((R)) have greater sensitivity in detecting anti-HLA antibodies but have not been directly evaluated versus BXM. We discuss our experience with Luminex testing and the significance of donor-specific antibodies (DSA) defined by Luminex in three populations, as compared with the CDC crossmatch. In the general transplant population, Luminex-defined DSA were found in only one third of positive CDC-BXM and were associated with graft rejection. Luminex testing enhanced the interpretation of CDC-BXM and identified patients with clinically relevant BXM. In the highly sensitized transplant population, Luminex-defined DSA were found in two thirds of positive BXM and were a better predictor of graft rejection. Therefore, Luminex assays rather than CDC-BXM should be used to facilitate kidney allocation in highly sensitized patients. In the post-transplantation population, Luminex antibody monitoring for DSA was shown to be important, as it defined low-level de novo DSA that were associated with development of transplant glomerulopathy and a significant predictor of graft loss in those patients. Thus Luminex testing facilitated the interpretation of CDC-BXM and provided a useful predictive tool for the detection of clinically significant DSA in post-transplantation antibody monitoring.
authors.affiliation: Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Hooi Sian
authors.initials: HS
authors.lastname: Eng
authors.forename: Greg
authors.initials: G
authors.lastname: Bennett
authors.forename: Peter
authors.initials: P
authors.lastname: Bardy
authors.forename: Patrick
authors.initials: P
authors.lastname: Coghlan
authors.forename: Graeme R
authors.initials: GR
authors.lastname: Russ
authors.forename: P Toby H
authors.initials: PT
authors.lastname: Coates
mesh_terms: D003951:Diagnostic Errors; D005434:Flow Cytometry; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis* / Q000276:immunology* / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007163:Immunosorbent Techniques; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation; D008863:Microspheres; D008991:Monitoring, Physiologic; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies