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. 2020 Sep;34(9):e14002.
doi: 10.1111/ctr.14002. Epub 2020 Jul 25.

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

Renaud Snanoudj  1 , Jérémy Siemowski  2 , Elizabeth Amankwa  2 , Vissal-David Kheav  2 , Nadia Arzouk  3 , Pierre Galichon  3 , Marie Matignon  4 , Christophe Legendre  5 , Michel Delahousse  1 , Sophie Caillat-Zucman  2   6 , Jean-Luc Taupin  2
Affiliations

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

Renaud Snanoudj et al. Clin Transplant. 2020 Sep.

Abstract

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.

Keywords: anti-HLA antibodies; antibody-mediated rejection; immunoassay; organ transplantation; screening.

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References

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