Specificity and Sensitivity of Screening for Anti-HLA Antibodies in Kidney Allograft Dysfunction
Autor(a) principal: | |
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Data de Publicação: | 2009 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.17/903 |
Resumo: | BACKGROUND: Prospective testing for posttransplant circulating anti-HLA antibodies seems to be a critical noninvasive tool, but confirmatory data are lacking. MATERIALS AND METHODS: Over the last 3 years, peritubular capillary (PTC) C4d deposition was prospectively sought by an immunofluorescence technique applied to frozen tissue in biopsies obtained for allograft dysfunction. Screening for circulating anti-HLA class I/II alloantibodies (AlloAb) by the flow cytometric test was performed simultaneously. RESULTS: We evaluated 132 sets of biopsies and simultaneous serum samples. PTC C4d deposition was demonstrated in 15.9% (21/132) of biopsies. Circulating anti-HLA I/II AlloAb were detected in 25% (33/132) of serum samples. Employing receiver-operator characteristic (ROC) curves for all C4d-positive biopsies, screening for AlloAb showed a global specificity of 82% and sensitivity of 61.9%. When this analysis was restricted to biopsies obtained in the first month posttransplantation, the sensitivity increased to 81.8%, but the specificity decreased to 76.9%. After the first month posttransplantation, we observed sensitivity of 40.0% and a specificity of 86.4%. In the first month posttransplantation, all patients with a diagnosis of acute antibody-mediated rejection displayed circulating anti-HLA class I/II, but not always at the same time as the C4d-positive biopsy. CONCLUSIONS: In the first month posttransplantation, prospective monitoring of anti-HLA antibodies may be useful. The high sensitivity allows the identification of patients at risk, affording an earlier diagnosis of antibody-mediated rejection. After the first month, the test can be used to evaluate allograft dysfunction episodes, since positivity is highly suggestive of an antibody-mediated process. |
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Specificity and Sensitivity of Screening for Anti-HLA Antibodies in Kidney Allograft DysfunctionMarcadores BiológicosBiópsiaComplemento C4bCitometria de FluxoAntigénio HLAAntigénio HLA-DAntigénio de Histocompatibilidade Classe ITransplantação de RimFragmentos de PeptídeosReoperaçãoSensibilidade e EspecificidadeTransplante HomólogoBACKGROUND: Prospective testing for posttransplant circulating anti-HLA antibodies seems to be a critical noninvasive tool, but confirmatory data are lacking. MATERIALS AND METHODS: Over the last 3 years, peritubular capillary (PTC) C4d deposition was prospectively sought by an immunofluorescence technique applied to frozen tissue in biopsies obtained for allograft dysfunction. Screening for circulating anti-HLA class I/II alloantibodies (AlloAb) by the flow cytometric test was performed simultaneously. RESULTS: We evaluated 132 sets of biopsies and simultaneous serum samples. PTC C4d deposition was demonstrated in 15.9% (21/132) of biopsies. Circulating anti-HLA I/II AlloAb were detected in 25% (33/132) of serum samples. Employing receiver-operator characteristic (ROC) curves for all C4d-positive biopsies, screening for AlloAb showed a global specificity of 82% and sensitivity of 61.9%. When this analysis was restricted to biopsies obtained in the first month posttransplantation, the sensitivity increased to 81.8%, but the specificity decreased to 76.9%. After the first month posttransplantation, we observed sensitivity of 40.0% and a specificity of 86.4%. In the first month posttransplantation, all patients with a diagnosis of acute antibody-mediated rejection displayed circulating anti-HLA class I/II, but not always at the same time as the C4d-positive biopsy. CONCLUSIONS: In the first month posttransplantation, prospective monitoring of anti-HLA antibodies may be useful. The high sensitivity allows the identification of patients at risk, affording an earlier diagnosis of antibody-mediated rejection. After the first month, the test can be used to evaluate allograft dysfunction episodes, since positivity is highly suggestive of an antibody-mediated process.ElsevierRepositório do Centro Hospitalar Universitário de Lisboa Central, EPEViana, HNolasco, FSantos, MCCarvalho, FGalvão, MJSantos, ARBordalo, JRibeiro Santos, J2012-12-20T16:01:19Z20092009-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/903engTransplant Proc. 2009 Apr;41(3):859-61info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:28:11Zoai:repositorio.chlc.min-saude.pt:10400.17/903Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:18:31.279659Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Specificity and Sensitivity of Screening for Anti-HLA Antibodies in Kidney Allograft Dysfunction |
title |
Specificity and Sensitivity of Screening for Anti-HLA Antibodies in Kidney Allograft Dysfunction |
spellingShingle |
Specificity and Sensitivity of Screening for Anti-HLA Antibodies in Kidney Allograft Dysfunction Viana, H Marcadores Biológicos Biópsia Complemento C4b Citometria de Fluxo Antigénio HLA Antigénio HLA-D Antigénio de Histocompatibilidade Classe I Transplantação de Rim Fragmentos de Peptídeos Reoperação Sensibilidade e Especificidade Transplante Homólogo |
title_short |
Specificity and Sensitivity of Screening for Anti-HLA Antibodies in Kidney Allograft Dysfunction |
title_full |
Specificity and Sensitivity of Screening for Anti-HLA Antibodies in Kidney Allograft Dysfunction |
title_fullStr |
Specificity and Sensitivity of Screening for Anti-HLA Antibodies in Kidney Allograft Dysfunction |
title_full_unstemmed |
Specificity and Sensitivity of Screening for Anti-HLA Antibodies in Kidney Allograft Dysfunction |
title_sort |
Specificity and Sensitivity of Screening for Anti-HLA Antibodies in Kidney Allograft Dysfunction |
author |
Viana, H |
author_facet |
Viana, H Nolasco, F Santos, MC Carvalho, F Galvão, MJ Santos, AR Bordalo, J Ribeiro Santos, J |
author_role |
author |
author2 |
Nolasco, F Santos, MC Carvalho, F Galvão, MJ Santos, AR Bordalo, J Ribeiro Santos, J |
author2_role |
author author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Viana, H Nolasco, F Santos, MC Carvalho, F Galvão, MJ Santos, AR Bordalo, J Ribeiro Santos, J |
dc.subject.por.fl_str_mv |
Marcadores Biológicos Biópsia Complemento C4b Citometria de Fluxo Antigénio HLA Antigénio HLA-D Antigénio de Histocompatibilidade Classe I Transplantação de Rim Fragmentos de Peptídeos Reoperação Sensibilidade e Especificidade Transplante Homólogo |
topic |
Marcadores Biológicos Biópsia Complemento C4b Citometria de Fluxo Antigénio HLA Antigénio HLA-D Antigénio de Histocompatibilidade Classe I Transplantação de Rim Fragmentos de Peptídeos Reoperação Sensibilidade e Especificidade Transplante Homólogo |
description |
BACKGROUND: Prospective testing for posttransplant circulating anti-HLA antibodies seems to be a critical noninvasive tool, but confirmatory data are lacking. MATERIALS AND METHODS: Over the last 3 years, peritubular capillary (PTC) C4d deposition was prospectively sought by an immunofluorescence technique applied to frozen tissue in biopsies obtained for allograft dysfunction. Screening for circulating anti-HLA class I/II alloantibodies (AlloAb) by the flow cytometric test was performed simultaneously. RESULTS: We evaluated 132 sets of biopsies and simultaneous serum samples. PTC C4d deposition was demonstrated in 15.9% (21/132) of biopsies. Circulating anti-HLA I/II AlloAb were detected in 25% (33/132) of serum samples. Employing receiver-operator characteristic (ROC) curves for all C4d-positive biopsies, screening for AlloAb showed a global specificity of 82% and sensitivity of 61.9%. When this analysis was restricted to biopsies obtained in the first month posttransplantation, the sensitivity increased to 81.8%, but the specificity decreased to 76.9%. After the first month posttransplantation, we observed sensitivity of 40.0% and a specificity of 86.4%. In the first month posttransplantation, all patients with a diagnosis of acute antibody-mediated rejection displayed circulating anti-HLA class I/II, but not always at the same time as the C4d-positive biopsy. CONCLUSIONS: In the first month posttransplantation, prospective monitoring of anti-HLA antibodies may be useful. The high sensitivity allows the identification of patients at risk, affording an earlier diagnosis of antibody-mediated rejection. After the first month, the test can be used to evaluate allograft dysfunction episodes, since positivity is highly suggestive of an antibody-mediated process. |
publishDate |
2009 |
dc.date.none.fl_str_mv |
2009 2009-01-01T00:00:00Z 2012-12-20T16:01:19Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/903 |
url |
http://hdl.handle.net/10400.17/903 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Transplant Proc. 2009 Apr;41(3):859-61 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Elsevier |
publisher.none.fl_str_mv |
Elsevier |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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