|Year : 2018 | Volume
| Issue : 1 | Page : 39-40
Pretransplant compatibility testing: Algorithmic approach!
Aseem K Tiwari, Rajni Chauhan
Department of Transfusion Medicine, Medanta The Medicity, Gurgaon, Haryana, India
|Date of Web Publication||5-Apr-2018|
Dr. Aseem K Tiwari
Department of Transfusion Medicine, Medanta The Medicity, Gurgaon, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tiwari AK, Chauhan R. Pretransplant compatibility testing: Algorithmic approach!. Glob J Transfus Med 2018;3:39-40
| Introduction|| |
Kidney transplantation is the preferred treatment in patients with end-stage renal disease. A systematic review analyzing 110 studies on renal transplantation had most studies finding significantly lower mortality associated with transplantation, and the relative magnitude of the benefit seemed to increase over time. Human leukocyte antigens (HLAs)play an important role in graft survival.
| Pretransplant Compatibility Tests|| |
Detection of HLA antibodies, particularly donor-specific antibodies (DSAs), is a crucial step in pretransplant assessment  for optimal donor selection and graft survival. The cell-based assay such as complement-dependent cytotoxicity crossmatch (CDCXM) was introduced in the 1960s. Over the years, other more sensitive methodologies based on flow cytometry and solid-phase immunoassays (SPI) have evolved. While positive CDCXM is considered a contraindication for transplantation, DSA detected by other assays represents varying degrees of risk. It is presently unclear which of the common test [Table 1] is most appropriate for the determination of unacceptable HLA antigen mismatch (UAM).
|Table 1: Commonly used methods available for the detection of alloantibodies|
Click here to view
| Pretransplant Compatibility Test Algorithm|| |
At present, the consensus  is that besides a cell-based assay, SPI must be used for the detection of pretransplantation HLA antibodies in solid organ transplants. Therefore, an algorithm comprising a combination of tests is used to determine UAM. UAM decides on the patient's chance to receive an organ; a restrictive defined UAM algorithm diminishes the chances of patient receiving an organ dramatically. Conversely, liberal defined UAM algorithm frequently leads to inferior graft survival.
There is a need for developing an appropriate algorithm for our resource constraint setting in India. This study  is one such welcome step in the direction of using an algorithm of cell-based CDCXM and SPI (Luminex XM [LXM]) test. However, since most of the transplant physicians did transplants in patients with CDC-negative–LXM-positive patients, the rate of AMR appears high. It would be a good idea to restrict transplants in CDC-negative–LXM-positive cases and thereby achieve lower rate of AMR. Authors are encouraged to adopt this algorithm with this new definition of UAM and prove this hypothesis. There is also need for many more reports on various algorithms being practiced and finally a consensus for the country to adopt.
| References|| |
Ingulli E. Mechanism of cellular rejection in transplantation. Pediatr Nephrol 2010;25:61-74.
Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, et al.
Systematic review: Kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant 2011;11:2093-109.
Tait BD. Detection of HLA antibodies in organ transplant recipients – Triumphs and challenges of the solid phase bead assay. Front Immunol 2016;7:570.
Tait BD. Solid phase assays for HLA antibody detection in clinical transplantation. Curr Opin Immunol 2009;21:573-7.
Tait BD, Süsal C, Gebel HM, Nickerson PW, Zachary AA, Claas FH, et al.
Consensus guidelines on the testing and clinical management issues associated with HLA and non-HLA antibodies in transplantation. Transplantation 2013;95:19-47.
Gebel HM, Bray RA, Nickerson P. Pre-transplant assessment of donor-reactive, HLA-specific antibodies in renal transplantation: Contraindication vs. risk. Am J Transplant 2003;3:1488-500.
Süsal C, Roelen DL, Fischer G, Campos EF, Gerbase-DeLima M, Hönger G, et al.
Algorithms for the determination of unacceptable HLA antigen mismatches in kidney transplant recipients. Tissue Antigens 2013;82:83-92.
Mathur A, Thapa S, Jagannathan L. Luminexbased donorspecific antibody cross matching for renal transplant: A 3 year experience in South India. Glob J Transfus Med 2018;3:34-8. [Full text]