Clinically relevant interpretation of solid phase assays for HLA antibody

Area of Science:

• Immunology
• Transplantation Science
• Clinical Chemistry

Background:

• Accurate human leukocyte antigen (HLA) antibody detection is critical for pre- and post-transplant immunological risk assessment.
• Solid phase immunoassays offer enhanced sensitivity and specificity but present interpretation challenges.

Purpose of the Study:

• To review the interpretation of HLA antibody detection results from solid phase immunoassays.
• To discuss technical limitations, assessment of antibody strength, and data integration for risk stratification.

Main Methods:

• Review of laboratory and clinical studies on HLA antibody detection.
• Analysis of causes for false positive and false negative reactions.
• Discussion of test modifications for detecting complement-binding antibodies and IgG subclasses.

Main Results:

• Identified causes of false positive/negative reactions, including antibodies to denatured HLA antigens and epitope loss.
• Highlighted the clinical relevance of antibodies to HLA-C, HLA-DQ, and HLA-DP antigens due to high specificity of assays.
• Demonstrated that determining antibody specificity for HLA epitopes aids in identifying incompatible antigens not covered by test kits.

Conclusions:

• Solid phase immunoassays have advanced the understanding of HLA antibodies' role in graft rejection and improved transplantation outcomes.
• Accurate interpretation of HLA antibody test results is essential for realizing the full benefits of these assays.