title: Utility of HLA Antibody Testing in Kidney Transplantation.
abstract: HLA antigens are polymorphic proteins expressed on donor kidney allograft endothelium and are critical targets for recipient immune recognition. HLA antibodies are risk factors for acute and chronic rejection and allograft loss. Solid-phase immunoassays for HLA antibody detection represent a major advance in sensitivity and specificity over cell-based methods and are widely used in organ allocation and pretransplant risk assessment. Post-transplant, development of de novo donor-specific HLA antibodies and/or increase in donor-specific antibodies from pretransplant levels are associated with adverse outcomes. Although single antigen bead assays have allowed sensitive detection of recipient HLA antibodies and their specificities, a number of interpretive considerations must be appreciated to understand test results in clinical and research contexts. This review, which is especially relevant for clinicians caring for transplant patients, discusses the technical aspects of single antigen bead assays, emphasizes their quantitative limitations, and explores the utility of HLA antibody testing in identifying and managing important pre- and post-transplant clinical outcomes.
authors: Department of Medicine, Division of Nephrology and.
authors: Ana
authors: A
authors: Konvalinka
authors: Department of Medicine, Division of Nephrology and Laboratory Medicine Program, HLA Laboratory, University Health Network, University of Toronto, Toronto, Ontario, Canada Kathryn.Tinckam@uhn.ca.
authors: Kathryn
authors: K
authors: Tinckam
mesh_terms: D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing / Q000706:statistics & numerical data*; D006801:Humans; D007111:Immunity, Cellular / Q000502:physiology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D014181:Transplantation Immunology / Q000276:immunology* / Q000502:physiology; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens
keywords: acute allograft rejection; chronic allograft failure; kidney transplantation