PMID- 23288109
OWN - NLM
STAT- MEDLINE
DCOM- 20130410
LR  - 20130222
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 95
IP  - 4
DP  - 2013 Feb 27
TI  - The DQ barrier: improving organ allocation equity using HLA-DQ information.
PG  - 635-40
LID - 10.1097/TP.0b013e318277b30b [doi]
AB  - BACKGROUND: The United Network for Organ Sharing algorithm for deceased-donor 
      kidney allocation considers only the human leukocyte antigen (HLA)-A, HLA-B, and 
      HLA-DR loci. Although HLA-DQ serologic specificities can be entered as 
      unacceptable antigens, they are assigned only by the identity of the DQbeta chain, 
      disregarding the role of the similarly polymorphic alpha chain. DQalpha/beta combinations 
      result in unique antigenic epitopes, which serve as targets to different 
      antibodies. Therefore, the presence of HLA antibodies to one DQalpha/beta combination 
      should not preclude negative crossmatch (XM) against another combination. In this 
      retrospective analysis, patients were allowed XM against a particular donor if 
      they had antibodies to some, but not all, DQalpha/beta allele combinations with the 
      donor serologic HLA-DQ antigens. METHODS: HLA antibody signature was obtained 
      using solid-phase Luminex-based antibody analysis. Results were captured at the 
      high-resolution level (as provided by the positive beads). Potential donors were 
      typed to include information on both HLA-DQA and HLA-DQB alleles. RESULTS: Of the 
      1130 flow XM assays performed, 147 patients had antibodies to donor serologic 
      HLA-DQ antigens. Thirty-five of those patients had antibodies to an allelic DQalpha/beta 
      combination within the donor serologic DQ specificity that were different from 
      the donor's DQalpha/beta, leading to negative flow XM results (24%). Virtual XM, 
      accounting for donor DQalpha/beta combinations, successfully predicts more than 98% of 
      XM outcomes. CONCLUSIONS: In patients with allelic DQalpha/beta antibodies, denying the 
      opportunity for XM based on serologically defined unacceptable antigens can 
      disadvantage the patient. Larger cohort studies are required to substantiate our 
      observation. Introducing DQalpha/beta combination information may increase virtual XM 
      accuracy and organ allocation equity.
FAU - Tambur, Anat R
AU  - Tambur AR
AD  - Transplant Immunology Laboratory, Comprehensive Transplant Center, Feinberg 
      School of Medicine, Northwestern University, 303 E. Chicago Avenue, Tarry 
      Building Suite 11-711, Chicago, IL 60611-3008, USA. a-tambur@northwestern.edu
FAU - Leventhal, Joseph R
AU  - Leventhal JR
FAU - Zitzner, Jennifer R
AU  - Zitzner JR
FAU - Walsh, R Carlin
AU  - Walsh RC
FAU - Friedewald, John J
AU  - Friedewald JJ
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (HLA-DQ Antigens)
RN  - 0 (HLA-DQ alpha-Chains)
RN  - 0 (HLA-DQ beta-Chains)
RN  - 0 (Isoantibodies)
SB  - IM
MH  - Aged
MH  - Algorithms
MH  - *Donor Selection
MH  - Female
MH  - Graft Rejection/immunology/*prevention & control
MH  - *Graft Survival
MH  - HLA-DQ Antigens/*immunology
MH  - HLA-DQ alpha-Chains/immunology
MH  - HLA-DQ beta-Chains/immunology
MH  - *Histocompatibility
MH  - *Histocompatibility Testing
MH  - Humans
MH  - Isoantibodies/*blood
MH  - Male
MH  - Organ Transplantation/*adverse effects
MH  - Predictive Value of Tests
MH  - Retrospective Studies
MH  - Time Factors
MH  - *Transplantation Tolerance
MH  - Treatment Outcome
EDAT- 2013/01/05 06:00
MHDA- 2013/04/11 06:00
CRDT- 2013/01/05 06:00
PHST- 2013/01/05 06:00 [entrez]
PHST- 2013/01/05 06:00 [pubmed]
PHST- 2013/04/11 06:00 [medline]
AID - 10.1097/TP.0b013e318277b30b [doi]
PST - ppublish
SO  - Transplantation. 2013 Feb 27;95(4):635-40. doi: 10.1097/TP.0b013e318277b30b.