PMID- 23995957
OWN - NLM
STAT- MEDLINE
DCOM- 20140220
LR  - 20131217
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 96
IP  - 12
DP  - 2013 Dec 27
TI  - HLA-DQ barrier: effects on cPRA calculations.
PG  - 1065-72
LID - 10.1097/TP.0b013e3182a452a5 [doi]
AB  - BACKGROUND: Panel-reactive antibody (PRA) testing provides assessment of the 
      breadth of sensitization a patient might have against human leukocyte antigen 
      (HLA) antigens. The evolution of calculated PRA (cPRA) reflects the commitment of 
      the transplant community to increase accessibility and promote equity to all 
      patients awaiting kidney transplantation. Recent data from our center and others, 
      however, suggested that a significant diversity of HLA-DQ antigens is not 
      captured, which may lead to inequity in allocating cPRA points. METHODS: 
      HLA-DRB1-DQA1-DQB1 typing of 2182 individuals was evaluated for this study using 
      Luminex-based sequence-specific oligonucleotide typing. A total of 3182 
      haplotypes were confirmed to have the level of resolution required for this 
      study. RESULTS: The diversity of HLA-DQalphabeta alleles is greater than what is 
      apparent using the serologic equivalents. The distribution of these alleles 
      within a serologic group varies, with some alleles being more frequent than 
      others; therefore, their representation within the current cPRA system is 
      inaccurate. Three informative examples are given. Haplotypes of DR antigens with 
      DQalphabeta alleles did not always follow the common published linkage disequilibrium, 
      especially in populations where there is greater genetic diversity. CONCLUSIONS: 
      The current cPRA system does not take into account the distribution of molecular 
      equivalents within DQ serologic specificities. This can result is inequitable 
      allocation of sensitization points and disadvantaging the more sensitized 
      patients. To ameliorate this situation, the United Network for Organ Sharing 
      system should allow inputting HLA-DQalphabeta alleles both for donor typing and as 
      antibody specificities, which will lead to better representation of unacceptable 
      DQ alleles and improve organ allocation equity.
FAU - Tambur, Anat R
AU  - Tambur AR
AD  - 1 Transplant Immunology Laboratory, Comprehensive Transplant Center, Feinberg 
      School of Medicine, Northwestern University, Chicago, IL. 2 Department of 
      Surgery, Comprehensive Transplant Center, Feinberg School of Medicine, 
      Northwestern University, Chicago, IL. 3 Department of Internal Medicine, 
      Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern 
      University, Chicago, IL. 4 Address correspondence to: Anat R. Tambur, D.M.D., 
      Ph.D., D[ABHI], Transplant Immunology Laboratory, Comprehensive Transplant 
      Center, Feinberg School of Medicine, Northwestern University, Chicago, IL.
FAU - Leventhal, Joseph R
AU  - Leventhal JR
FAU - Walsh, R Carlin
AU  - Walsh RC
FAU - Zitzner, Jennifer R
AU  - Zitzner JR
FAU - Friedewald, John J
AU  - Friedewald JJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (Antibodies)
RN  - 0 (HLA-DQ Antigens)
RN  - 0 (Oligonucleotides)
SB  - IM
MH  - Algorithms
MH  - Alleles
MH  - Antibodies/*immunology
MH  - Genetic Variation
MH  - HLA-DQ Antigens/*genetics
MH  - *Histocompatibility Testing/methods
MH  - Humans
MH  - *Immunophenotyping
MH  - Linkage Disequilibrium
MH  - Oligonucleotides
MH  - Organ Transplantation
MH  - Tissue and Organ Procurement/standards
EDAT- 2013/09/03 06:00
MHDA- 2014/02/22 06:00
CRDT- 2013/09/03 06:00
PHST- 2013/09/03 06:00 [entrez]
PHST- 2013/09/03 06:00 [pubmed]
PHST- 2014/02/22 06:00 [medline]
AID - 10.1097/TP.0b013e3182a452a5 [doi]
PST - ppublish
SO  - Transplantation. 2013 Dec 27;96(12):1065-72. doi: 10.1097/TP.0b013e3182a452a5.