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Predictive value of mixed antigen screen beads in pre‐transplant assessment of HLA immunization in solid organ transplant recipients
Author(s) -
Snanoudj Renaud,
Siemowski Jérémy,
Amankwa Elizabeth,
Kheav VissalDavid,
Arzouk Nadia,
Galichon Pierre,
Matig Marie,
Legendre Christophe,
Delahousse Michel,
CaillatZucman Sophie,
Taupin JeanLuc
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14002
Subject(s) - medicine , human leukocyte antigen , antibody , predictive value , immunology , antigen , organ transplantation , transplantation , immunization
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.