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Patients Awaiting Renal Transplantation in South Africa: The Need for Highly Sensitive Laboratory Testing and Immunological Risk Stratification by Catherine M. Worsley, Elizabeth S. Mayne

Background: Suitable laboratory testing prior to transplantation ensures that a patient’s immunological risk is understood and allows the transplantation team to make the correct decisions on donor-recipient pairing. Preformed donor-specific anti-HLA antibodies mediate rejection in transplanted patients. Improved laboratory testing is needed to increase the chances of successful organ allocation. In this study, we show how Luminex™ single antigen assays are vital in determining immunological risk to transplantation and in predicting waiting time to transplantation.
Methods: Potential recipients awaiting renal transplantation (deceased donor) were tested using Luminex™ single antigen testing. HLA class I and II antibody specificities were determined, and patient demographics were analyzed for each blood group. Antibody reactivity was compared between patients who were transplanted or not transplanted in each blood group. Immunological risk to successful transplantation was determined retrospectively for all patients.
Results: Patient demographics were reported for the cohort. More males await renal transplantation than females (male:female ratio of 1.84:1). The median age of the patients was similar between the blood groups (between 41 and 44.5 years), as was the median time spent on the waiting list (between 3 - 4 years). Patients who were transplanted had significantly reduced HLA antibody expression compared to those who were not transplanted (total median reactivity 2 versus 8%, p = 0.0006). Patients were retrospectively stratified according to HLA antibody expression as a surrogate marker for immunological risk. Those in the high-risk group spent longer on the waiting list and had a low chance of being transplanted.
Conclusions: Risk stratification can be used as a tool in predicting likelihood of successful transplantation. Laboratories in South Africa should move towards implementing highly sensitive, highly specific diagnostic assays in order to improve successful organ allocation. This will aid in standardizing testing algorithms in order to transplant more recipients.

DOI: 10.7754/Clin.Lab.2018.180414