Journal ArticleDOI
Consensus guidelines on the testing and clinical management issues associated with HLA and non-HLA antibodies in transplantation.
Brian D. Tait,Caner Süsal,Howard M. Gebel,Peter Nickerson,Andrea A. Zachary,Frans H.J. Claas,Elaine F. Reed,Robert A. Bray,Patricia Campbell,Jeremy R. Chapman,P. Toby Coates,Robert B. Colvin,Emanuele Cozzi,Ilias I.N. Doxiadis,Susan V. Fuggle,John S. Gill,Denis Glotz,Nils Lachmann,Thalachallour Mohanakumar,Nicole Suciu-Foca,Suchitra Sumitran-Holgersson,Kazunari Tanabe,Craig J. Taylor,Dolly B. Tyan,Angela C Webster,Adriana Zeevi,Gerhard Opelz +26 more
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A group of laboratory and clinical experts in the field of transplantation was convened to prepare a consensus report and make recommendations on the use of this new technology based on both published evidence and expert opinion.Abstract:
BACKGROUND The introduction of solid-phase immunoassay (SPI) technology for the detection and characterization of human leukocyte antigen (HLA) antibodies in transplantation while providing greater sensitivity than was obtainable by complement-dependent lymphocytotoxicity (CDC) assays has resulted in a new paradigm with respect to the interpretation of donor-specific antibodies (DSA). Although the SPI assay performed on the Luminex instrument (hereafter referred to as the Luminex assay), in particular, has permitted the detection of antibodies not detectable by CDC, the clinical significance of these antibodies is incompletely understood. Nevertheless, the detection of these antibodies has led to changes in the clinical management of sensitized patients. In addition, SPI testing raises technical issues that require resolution and careful consideration when interpreting antibody results. METHODS With this background, The Transplantation Society convened a group of laboratory and clinical experts in the field of transplantation to prepare a consensus report and make recommendations on the use of this new technology based on both published evidence and expert opinion. Three working groups were formed to address (a) the technical issues with respect to the use of this technology, (b) the interpretation of pretransplantation antibody testing in the context of various clinical settings and organ transplant types (kidney, heart, lung, liver, pancreas, intestinal, and islet cells), and (c) the application of antibody testing in the posttransplantation setting. The three groups were established in November 2011 and convened for a "Consensus Conference on Antibodies in Transplantation" in Rome, Italy, in May 2012. The deliberations of the three groups meeting independently and then together are the bases for this report. RESULTS A comprehensive list of recommendations was prepared by each group. A summary of the key recommendations follows. Technical Group: (a) SPI must be used for the detection of pretransplantation HLA antibodies in solid organ transplant recipients and, in particular, the use of the single-antigen bead assay to detect antibodies to HLA loci, such as Cw, DQA, DPA, and DPB, which are not readily detected by other methods. (b) The use of SPI for antibody detection should be supplemented with cell-based assays to examine the correlations between the two types of assays and to establish the likelihood of a positive crossmatch (XM). (c) There must be an awareness of the technical factors that can influence the results and their clinical interpretation when using the Luminex bead technology, such as variation in antigen density and the presence of denatured antigen on the beads. Pretransplantation Group: (a) Risk categories should be established based on the antibody and the XM results obtained. (b) DSA detected by CDC and a positive XM should be avoided due to their strong association with antibody-mediated rejection and graft loss. (c) A renal transplantation can be performed in the absence of a prospective XM if single-antigen bead screening for antibodies to all class I and II HLA loci is negative. This decision, however, needs to be taken in agreement with local clinical programs and the relevant regulatory bodies. (d) The presence of DSA HLA antibodies should be avoided in heart and lung transplantation and considered a risk factor for liver, intestinal, and islet cell transplantation. Posttransplantation Group: (a) High-risk patients (i.e., desensitized or DSA positive/XM negative) should be monitored by measurement of DSA and protocol biopsies in the first 3 months after transplantation. (b) Intermediate-risk patients (history of DSA but currently negative) should be monitored for DSA within the first month. If DSA is present, a biopsy should be performed. (c) Low-risk patients (nonsensitized first transplantation) should be screened for DSA at least once 3 to 12 months after transplantation. If DSA is detected, a biopsy should be performed. In all three categories, the recommendations for subsequent treatment are based on the biopsy results. CONCLUSIONS A comprehensive list of recommendations is provided covering the technical and pretransplantation and posttransplantation monitoring of HLA antibodies in solid organ transplantation. The recommendations are intended to provide state-of-the-art guidance in the use and clinical application of recently developed methods for HLA antibody detection when used in conjunction with traditional methods.read more
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The Banff 2015 Kidney Meeting Report: Current Challenges in Rejection Classification and Prospects for Adopting Molecular Pathology.
Alexandre Loupy,Mark Haas,Kim Solez,Lorraine C. Racusen,Denis Glotz,Daniel Serón,Brian J. Nankivell,Robert B. Colvin,Marjan Afrouzian,Enver Akalin,Nada Alachkar,Serena M. Bagnasco,Jan U. Becker,Lynn D. Cornell,Cinthia B. Drachenberg,Duska Dragun,H. de Kort,Ian W. Gibson,Edward S. Kraus,Carmen Lefaucheur,Ch. Legendre,Helen Liapis,Thangamani Muthukumar,Volker Nickeleit,Babak J. Orandi,Walter D. Park,Marion Rabant,Parmjeet Randhawa,Elaine F. Reed,Candice Roufosse,Surya V. Seshan,Banu Sis,Harsharan K. Singh,Carrie A. Schinstock,Anat R. Tambur,A. Zeevi,Michael Mengel +36 more
TL;DR: Improved definitions of TCMR and ABMR in pancreas transplants with specification of vascular lesions and prospects for defining a vascularized composite allograft rejection classification are included.
Journal ArticleDOI
A 2018 Reference Guide to the Banff Classification of Renal Allograft Pathology.
Candice Roufosse,Naomi Simmonds,Marian C. Clahsen-van Groningen,Mark Haas,Kammi J. Henriksen,Catherine Horsfield,Alexandre Loupy,Michael Mengel,Agnieszka Perkowska-Ptasińska,Marion Rabant,Lorraine C. Racusen,Kim Solez,Jan U. Becker +12 more
TL;DR: This review shall provide a complete and simple illustrated reference guide of the Banff Classification of Kidney Allograft Pathology based on all publications including the 2017 update, intended as a concise desktop reference for pathologists and clinicians.
Journal ArticleDOI
KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors.
Krista L. Lentine,Bertram L. Kasiske,Andrew S. Levey,Patricia L. Adams,Josefina Alberú,Mohamed A. Bakr,Lorenzo Gallon,Catherine A. Garvey,S. Guleria,Philip Kam-Tao Li,Dorry L. Segev,Sandra J. Taler,Kazunari Tanabe,Linda Wright,Martin Zeier,Michael Cheung,Amit X. Garg +16 more
TL;DR: The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation, and proposed a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making.
Journal ArticleDOI
Therapeutic Drug Monitoring of Tacrolimus-Personalized Therapy : Second Consensus Report
Mercè Brunet,Teun van Gelder,Anders Åsberg,Vincent Haufroid,Vincent Haufroid,Dennis A. Hesselink,Loralie J. Langman,Florian Lemaitre,Pierre Marquet,Christoph Seger,Maria Shipkova,Alexander A. Vinks,Alexander A. Vinks,Pierre Wallemacq,Eberhard Wieland,Jean-Baptiste Woillard,Markus J. Barten,Klemens Budde,Helena Colom,Maja Theresa Dieterlen,Laure Elens,Kamisha L. Johnson-Davis,Paweł K. Kunicki,Iain MacPhee,Satohiro Masuda,Binu S. Mathew,Olga Millán,Tomoyuki Mizuno,Tomoyuki Mizuno,Dirk Jan A.R. Moes,Caroline Monchaud,Ofelia Noceti,Tomasz Pawinski,Nicolas Picard,Ron H.N. van Schaik,Claudia Sommerer,Nils Tore Vethe,Brenda C. M. de Winter,Uwe Christians,Stein Bergan +39 more
TL;DR: It is concluded that considerable advances in the different fields of tacrolimus monitoring have been achieved during this last decade, and the Expert Committee concludes that Continued efforts should focus on the opportunities to implement in clinical routine the combination of new standardized PK approaches with PG, and valid biomarkers to further personalize tacolimus therapy and to improve long-term outcomes for treated patients.
Journal ArticleDOI
Antibody-Mediated Rejection of Solid-Organ Allografts.
TL;DR: This review focuses on current standards for management of antibody-mediated rejection in solid-organ transplant recipients and emphasizes the importance of informed consent for the use of antibodies for organ transplantation.
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Microdroplet Assay of Human Serum Cytotoxins
TL;DR: The method recorded here for assaying lymphocyte cytotoxins in a microscale was developed to circumvent difficulties in handling small quantities of serum and cells and in gaining a greater than ten-fold increase in sensitivity over present-day methods.
Journal ArticleDOI
Significance of the positive crossmatch test in kidney transplantation.
Ramon Patel,Paul I. Terasaki +1 more
TL;DR: Crossmatch tests of the prospective kidney-transplant donor's lymphocytes with the serum of thespective recipient in 225 transplants showed that eight of 195 with negative crossmatch tests for the prospective recipient were found to be positive.
Journal ArticleDOI
Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence.
Joana Sellarés,D. G. de Freitas,Michael Mengel,Jeff Reeve,Gunilla Einecke,Banu Sis,Luis G. Hidalgo,Konrad S. Famulski,Arthur J. Matas,Philip F. Halloran +9 more
TL;DR: This prospective cohort indicates that many actual failures after indication biopsies manifest phenotypic features of antibody‐mediated or mixed rejection and also underscores the major role of nonadherence.
Journal ArticleDOI
Banff '05 Meeting Report: differential diagnosis of chronic allograft injury and elimination of chronic allograft nephropathy ('CAN').
Kim Solez,Robert B. Colvin,Lorraine C. Racusen,Banu Sis,Philip F. Halloran,Patricia E. Birk,Patricia Campbell,Marilia Cascalho,A. B. Collins,Anthony J. Demetris,Cinthia B. Drachenberg,Ian W. Gibson,Paul C. Grimm,Mark Haas,Evelyne Lerut,Helen Liapis,Roslyn B. Mannon,P. B. Marcus,Michael Mengel,Michael J. Mihatsch,Brian J. Nankivell,Volker Nickeleit,John C. Papadimitriou,Jeffrey L. Platt,Parmjeet Randhawa,Ian Roberts,L. Salinas-Madriga,Daniel R. Salomon,Daniel Serón,M. Sheaff,Jan J. Weening +30 more
TL;DR: The 8th Banff Conference on Allograft Pathology was held in Edmonton, Canada, 15–21 July 2005, and major outcomes included the elimination of the non‐specific term ‘chronic allograft nephropathy’ (CAN) and the recognition of the entity of chronic antibody‐mediated rejection.
Journal ArticleDOI
Antibody-mediated rejection criteria - an addition to the Banff 97 classification of renal allograft rejection.
Lorraine C. Racusen,Robert B. Colvin,Kim Solez,Michael J. Mihatsch,Philip F. Halloran,Patricia Campbell,Michael Cecka,Jean Pierre Cosyns,Anthony J. Demetris,Michael C. Fishbein,Agnes B. Fogo,Peter N. Furness,Ian W. Gibson,Denis Glotz,Pekka Häyry,Lawrence Hunsickern,Michael Kashgarian,Ronald H. Kerman,Alex J. Magil,Robert A. Montgomery,Kunio Morozumi,Volker Nickeleit,Parmjeet Randhawa,Heinz Regele,Daniel Serón,Surya V. Seshan,Stale Sund,Kiril Trpkov +27 more
TL;DR: This article presents international consensus criteria for and classification of AbAR developed based on discussions held at the Sixth Banff Conference on Allograft Pathology in 2001, to be revisited as additional data accumulate in this important area of renal transplantation.
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