Juhl David, Marget Matthias, Hallensleben Michael, Görg Siegfried, Ziemann Malte
Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck/Kiel, Germany.
Department of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Transpl Immunol. 2017 Mar;41:17-21. doi: 10.1016/j.trim.2017.01.001. Epub 2017 Jan 12.
Soon, a virtual crossmatch shall replace the complement-dependent cytotoxicity (CDC) allocation crossmatch in the Eurotransplant region. To prevent positive CDC-crossmatches in the recipient centre, careful definition of unacceptable antigens is necessary. For highly sensitized patients, this is difficult by CDC alone. Assignment of all antibodies detected by sensitive assays, however, could prevent organ allocation. To assess the usefulness of the Luminex C1q-assay to prevent positive CDC-crossmatches, all CDC-crossmatches performed prior to deceased kidney transplantation in a 16-month-period were reviewed. Sera causing positive crossmatches were investigated by the C1q-assay. 31 out of 1432 crossmatches (2.2%) were positive. Sera involved in 26 positive crossmatches were available. C1q-binding donor-specific antibodies were detected in 19 sera (73.1%). The other sera were from recipients without any HLA antibodies detectable by CDC or common solid phase assays. Three patients had known Non-HLA antibodies causing positive CDC-results. Four crossmatches were only weak positive. Therefore, avoidance of donors with HLA antigens against whom C1q-binding antibodies were detected would have prevented all positive crossmatches due to HLA antibodies. Provided that all HLA specificities against which antibodies are detected by the Luminex C1q-assay are considered as unacceptable antigens, CDC-crossmatches prior to transplantation might safely be omitted in many patients. They should be maintained in highly immunized patients, however, for whom assignment of all C1q-positive antibodies as unacceptable antigens could lead to a significant delay or even prevention of transplantation.
不久之后，虚拟交叉配型将取代欧洲移植区域内依赖补体的细胞毒性（CDC）分配交叉配型。为防止受者中心出现阳性CDC交叉配型，必须仔细定义不可接受的抗原。对于高度致敏患者，仅靠CDC很难做到这一点。然而，将敏感检测方法检测到的所有抗体进行分配可能会阻碍器官分配。为评估Luminex C1q检测在防止阳性CDC交叉配型方面的效用，我们回顾了16个月期间在 deceased 肾移植前进行的所有CDC交叉配型。通过C1q检测对导致交叉配型阳性的血清进行了研究。1432次交叉配型中有31次（2.2%）呈阳性。有26次阳性交叉配型所涉及的血清可供检测。在19份血清（73.1%）中检测到了与C1q结合的供者特异性抗体。其他血清来自那些通过CDC或常规固相检测未检测到任何HLA抗体的受者。有3例患者已知存在导致CDC结果呈阳性的非HLA抗体。有4次交叉配型仅为弱阳性。因此，避免使用具有能被检测到与C1q结合抗体所针对的HLA抗原的供者，本可防止所有由HLA抗体导致的阳性交叉配型。如果将Luminex C1q检测所检测到抗体的所有HLA特异性都视为不可接受的抗原，那么在许多患者中移植前或许可以安全地省略CDC交叉配型。然而，对于高度免疫的患者，仍应进行CDC交叉配型，因为将所有C1q阳性抗体都指定为不可接受的抗原可能会导致移植显著延迟甚至无法进行。
