Thammanichanond Duangtawan, Sukhumvat Sireewan, Tammakorn Chutima, Siriyotha Sukanya, Kantachuvesiri Surasak
Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Transplant Proc. 2020 Jul-Aug;52(6):1675-1679. doi: 10.1016/j.transproceed.2020.01.153. Epub 2020 May 21.
The determination of unacceptable antigens in patients on kidney transplant waiting list is a critical laboratory investigation in sensitized patients. The Luminex single antigen bead (SAB) assay has high sensitivity and accuracy. However, several countries have not yet implemented SAB testing for waitlisted patients because of limited financial resources. In Thailand, specificities of HLA antibodies are identified by using a phenotypic bead assay. The aim of this study was to evaluate the performance of the phenotypic bead assay for determining HLA antibody specificities when compared with the SAB assay.
A total of 254 sera from patients awaiting kidney transplantation were included. Of 254 sera, 206 and 171 were positive for HLA class I and II antibodies, respectively. Antibody specificities of sera that were tested with both phenotypic and SAB assay were analyzed. The performances of the phenotypic bead assay were compared with those of the SAB assay as the gold standard by using estimation of pooling sensitivity, specificity, and accuracy.
The sensitivity, specificity, and accuracy of the phenotypic bead assay for determining HLA class I antibodies was 53.9%, 93.0%, and 78.1%, respectively. The sensitivity, specificity, and accuracy of the phenotypic bead assay for determining HLA class II antibodies were 57.3%, 94.9%, and 81.4% respectively.
In waitlisted kidney transplant patients, the phenotypic bead assay had high specificity and moderate accuracy when compared with the SAB assay. However, the low sensitivity of the test suggests that the use of the phenotypic assay for determining HLA specificities should be applied with caution in sensitized patients.
确定肾移植等待名单上患者体内不可接受的抗原，对于致敏患者而言是一项关键的实验室检查。Luminex单抗原微珠（SAB）检测具有高灵敏度和准确性。然而，由于资金有限，一些国家尚未对等待名单上的患者开展SAB检测。在泰国，通过使用表型微珠检测来鉴定HLA抗体的特异性。本研究的目的是评估与SAB检测相比，表型微珠检测在确定HLA抗体特异性方面的性能。
共纳入254例等待肾移植患者的血清。在这254份血清中，分别有206份和171份HLAⅠ类和Ⅱ类抗体呈阳性。对同时采用表型和SAB检测的血清的抗体特异性进行分析。通过合并灵敏度、特异性和准确性的估计，将表型微珠检测的性能与作为金标准的SAB检测进行比较。
表型微珠检测确定HLAⅠ类抗体的灵敏度、特异性和准确性分别为53.9%、93.0%和78.1%。表型微珠检测确定HLAⅡ类抗体的灵敏度、特异性和准确性分别为57.3%、94.9%和81.4%。
在等待肾移植的患者中，与SAB检测相比，表型微珠检测具有较高的特异性和中等的准确性。然而，该检测的低灵敏度表明，在致敏患者中使用表型检测来确定HLA特异性时应谨慎应用。
