Modified urine typing to enhance clinical management in kidney transplant patients with unknown donor human leukocyte antigen typing: abridged secondary publication
JCY Ho1, YH Yu1, LCW Choi1, IWH Tang1, SLK Ng1, WLC Tsang1, SKS Fung2, TH Kwan3, PKT Li4, CB Leung4, WL Chak5, S Wong6, SK Mak7, DSP Yong8, S Yeung9, S Lo10, DTM Chan11, JSY Kwok1
1 Division of Transplantation and Immunogenetics, Queen Mary Hospital, Hong Kong
2Jockey Club Nephrology & Urology Centre, Princess Margaret Hospital, Hong Kong
3 Department of Medicine & Geriatrics, Tuen Mun Hospital
4 Department of Medicine & Geriatrics, Tuen Mun Hospital
5 Department of Medicine, Queen Elizabeth Hospital
6 Department of Medicine & Geriatrics, United Christian Hospital
7 Department of Medicine & Geriatrics, Kwong Wah Hospital
8 Department of Medicine, Caritas Medical Centre
9 Department of Medicine, Tseung Kwan O Hospital
10 Department of Medicine, Pamela Youde Nethersole Eastern Hospital
11 Department of Medicine, Queen Mary Hospital
1. Availability of donor human leukocyte antigen (HLA) typing is crucial for early diagnosis of antibody-mediated rejection (AMR) and prompt medical intervention to salvage the graft from failure. Recipients’ urine samples are valuable for deduction of donor HLA typing.
2. In 727 urine samples collected from recipients of kidney transplantations, donor mismatched HLA antigens were successfully deduced from 79.0% of the samples.
3. Anti-HLA IgG antibodies against HLA Class I and Class II antigens were detected in 27.9% of the patients. Presence of donor-specific antibody (DSA) was found in 11.1% of the patients. The DSA correlation rate was comparable to that in patients who received transplantations in Hong Kong with known donor typing.
4. With early detection of DSA, AMR were under control in 88.5% patients. Allograft failure with histologic AMR was found in 11.5% of patients before the commencement of this study.
5. This protocol can complement earlier transplant recipients with incomplete donor typing of the newly defined antigens such as HLA-C and -DQ.