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CDC (compliment dependent cytotoxicity testing) and Donor Specific Antibody (DSA) Detection by Single Antigen Beads (SAB) Assay for Acute Antibody Mediated Rejection (ABMR) Risk Assessment

Mehrotra, Sonia; Sharma, Raj Kumar; Prasad, Narayan; Gupta, Amit; Kaul, Anupma; Bhadauria, Dharmendra Singh

doi: 10.1097/

Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

In our centre 38 recipients (pre-transplant) were evaluated by traditional CDC cross-match and SAB assay. Pre- existent HLA antibodies were detected in to recipient’s serum sample by SAB (Single Antigen Bead) assay (one lembda) on luminex platform.

All these 38 pre-kidney transplanted recipients were first CDC cross-match negative at room, warm and cold temperature. Those who had final CDC cross-match negative and pre- existent HLA antibodies < 1000 MFI under went for KT.

Out of 38 recipients only18 were transplanted and post transplantation within three months of duration 10 recipients out of 18 were positive in the terms of virtual cross match (SAB against their donor), 8 recipients were negative in the terms of virtual cross match (SAB against their donor). In negative group 7 were no incident of acute rejection after kidney transplantation only 1 recipient had border line acute rejection.10 recipients those who were positive for virtual cross match (post-transplant SAB assay MFI values were <1000 to >21000) 9 recipients were developed acute rejection and 1 was CNI toxicity after within three months of transplantation. The acute rejection was significantly associated with those who were positive for virtual cross match (p-value < 0.01) and with ABMR (p-value < 0.00).

There was higher incident of acute rejection (ABMR) in recipient with pre- existent HLA antibodies (donor specific antibodies) against their donor by SAB assay despite their CDC cross-match were negative. Highly sensitive micro bead based luminex assay can detect low levels of anti HLA antibodies (donor specific antibodies). Pre-transplantation SAB assay by luminex is significant impact on graft survival. Patients with donor specific anti HLA antibodies had positive correlation with antibody mediated rejection, were 18.7 times more possibilities to had acute rejection.

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