Utilize este identificador para referenciar este registo: http://hdl.handle.net/10400.17/903
Título: Specificity and Sensitivity of Screening for Anti-HLA Antibodies in Kidney Allograft Dysfunction
Autor: Viana, H
Nolasco, F
Santos, MC
Carvalho, F
Galvão, MJ
Santos, AR
Bordalo, J
Ribeiro Santos, J
Palavras-chave: 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
Data: 2009
Editora: Elsevier
Citação: Transplant Proc. 2009 Apr;41(3):859-61
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.
Peer review: yes
URI: http://hdl.handle.net/10400.17/903
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