Optimizing The Assessment Of Pathogenic Anti-Hla Antibodies

We read with interest the paper by Visentin et al. entitled \"Reassessment of the clinical impact of preformed donor-specific anti-HLA-Cw antibodies in kidney transplantation1 .\" Using single antigen flow beads (SAFB) from One Lambda, Inc, this paper highlights and adds to their prior work2 demonstrating the pathogenicity of anti-HLA antibodies directed against native, trimeric (α-chain, β2-microglobulin, peptide) HLA class-I molecules (nHLA), whereas those antibodies directed against \"denatured\" (α-chain only, dHLA) class-I molecules appear benign. In their current paper, antibodies directed solely against dHLA Cw did not predict positive T-cell flow crossmatches and were not associated with adverse outcomes post-transplantation. Sera were considered reactive with only dHLA if positive with standard SAFBs (contain both nHLA and dHLA), but were negative with iBeads (devoid of dHLA). Unfortunalely, as the authors point out, iBeads are no longer commercially available.