Terasaki Festschrift 2014 Clinical Relevance of Pre- and Post-Transplant HLA antibodies,...

Terasaki Festschrift 2014

Clinical Relevance of Pre- and Post-Transplant HLA antibodies, Donor-Specific and Non-Donor-Specific HLA Antibodies Detected

by ELISA in Renal Transplantation

Po-Chang Lee, M.D.,M.T.L.

Professor of SurgeryNational Cheng Kung University Hospital, TaiwanChairperson of the BoardTaiwan Organ Registry and Sharing Center

De novo Post-Transplant Antibody

0 <6M1yr 2 3 4 5 6 7 8yr

Lee PC, Terasaki PI, et al. Transplantation 2002; 74(8): 1192-1194

2. Dangerous

Late

Failure Early

Lee, PC, Terasaki, et al, Early antibodies Transplantation 2009;88:568-574

HLA Abs detected method and cost

• ELISA• LATM (Screening): US12• LAT (Identification): US60

• Luminex• LAB (single antigen bead

assay): US 558

Table 1. Patient characteristics HLA- (n= 162) HLA+ (n= 18) P-ValueAge (years) 40.9±13.0 45.7±10.6 0.134Sex (Male) 77 (48%) 13 (72%) 0.047*Source (Living) 75 (46%) 11 (61%) 0.233Donor Blood type

A 54 (33%) 6 (33%) 0.988B 41 (25%) 4 (22%) O 52 (32%) 6 (33%) AB 15 (9%) 2 (11%)

Receiver Blood type A 46 (28%) 5 (28%) 0.952B 35 (22%) 4 (22%) O 69 (43%) 7 (39%) AB 12 (32%) 2 (11%)

CDC XM 154 (95%) 15 (83%) <0.001*DTT CDC XM 8 (5%) 3 (17%)

HBV (+) 19 (12%) 1 (6%) 0.698HCV (+) 18 (11%) 2 (11%) 1.000Patient survival follow up 33.2±21.5 18.9±13.3 <0.001*Graft survival follow up 31.9±21.5 18.8±13.3 0.001*

Figure 1. Pre- Transplant HLA Antibodies being Detected

DSA vs NDSA vs HLA Ab(－ )DSA vs HLA Ab

(－ )NDSA vs HLA Ab

(－ )

OD=2 P=0.111 (N=6 vs 12 vs 162) 0.208 0.065*

OD=4 P=0.015* (N=5 vs 13 vs 162) 0.615 0.0005*

OD=6 P=0.032* (N=3 vs 15 vs 162) 0.677 0.010*

OD=8 P=0.093 (N=1 vs 17 vs 162) 0.851 0.029*

Table 2. Comparison of Graft Survival According to Pre-transplant HLA

Antibodies, DSA and NDSA being Detected

Figure 2. Post-transplant HLA Antibodies being Detected

DSA vs NDSA vs HLA Ab

(－ )DSA vs HLA Ab

(－ )NDSA vs HLA Ab

(－ )

OD=2 P=0.064 (N=13 vs 19 vs 148) 0.047* 0.290

OD=4 P=0.186 (N=9 vs 23 vs 148) 0.084 0.717

OD=6 P=0.015 (N=4 vs 28 vs 148) 0.006* 0.599

OD=8 P=0.912 (N=1 vs 31 vs 148) 0.124 0.895

Table 3. Comparison of Graft Survival According to Post-transplant HLA Antibodies, DSA and NDSA being Detected

Figure 3. Post-transplant HLA Antibodies to Class I or Class II being Detected

Pre- / Post- transplant 3 years GS 5 years GS P-Value

＋ /＋ (N=14) vs ＋ /－ (N=4) 65.6% vs 100% 　 65.6% vs 100% 0.362

＋ /＋ (N=14) vs － /＋(N=18)

65.6% vs 100% 65.6% vs 100% 0.043*

＋ /＋ (N=14) vs － /－(N=144)

65.6% vs 92.0% 65.6% vs 85.5% 0.015*

＋ /－ (N=4) vs － /＋(N=18)

100% vs 100% 　 100% vs 100% 1.0

＋ /－ (N=4) vs － /－(N=144)

100% vs 92.0% 100% vs 85.5% 0.656

－ /＋ (N=18) vs － /－(N=144)

100% vs 92.0% 100% vs 85.5% 0.966

Table 4. Comparison of Graft Survival According to Pre-transplant and Post-transplant HLA Antibodies being Detected

Figure 4. Comparison of Graft Survival According to Pre- transplant CDC-XM and DTT CDC-XM

Take Home Message1. There was a significant difference in graft survival

between patients with pre-transplant NDSA and those without HLA antibodies (P=0.0005) .

2. There was a significant difference in graft survival between patients with post-transplant DSA and those without HLA antibodies (P=0.006) .

3. For patients who had persistent pre- and post-transplant HLA antibodies, worst long term survival could be found.

4, We believe HLA antibody analysis by ELISA is still very useful for transplantation.

National Cheng Kung University Hospital, Tainan, Taiwan

Q & A