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P162 Unexpected positive flow crossmatch with a deceased donor organ: Timing of autologous flow crossmatch?
Abstracts / Human Immunology 77 (2016) 40–156
P162
UNEXPECTED POSITIVE FLOW CROSSMATCH WITH A DECEASED DONOR ORGAN: TIMING OF AUTOLOGOUS FLOW CROSSMATCH? Justin Kreuter, Lisa Hallaway, Laurie Wakefield, Manish Gandhi. Mayo Clinic, Rochester, MN, United States. We describe two recipients of deceased donor organs who had a positive flow crossmatch despite being negative for donor specific antibodies (DSA), as determined by single antigen beads (SAB; LabScreen, One Lambda). The first patient, a 56 year old male, was offered a kidney from a deceased donor. The positive allogeneic flow crossmatch results are shown in Table 1. Interestingly, a recent SAB was negative for DSA. To facilitate clinical interpretation, an autologous flow crossmatch was immediately performed, which demonstrated significant auto-reactivity. Therefore, the positive allogeneic flow crossmatch was interpreted as most likely due to auto-reactive antibodies and the medical decision was to proceed with transplantation. The second patient, a 60 year old female, was offered a kidney from a deceased donor. The positive allogeneic flow crossmatch results are shown in Table 1. A recent SAB was negative for any antibodies greater than mean fluorescence intensity of 300. An autologous flow crossmatch was immediately performed, which demonstrated significant, although somewhat attenuated, auto-reactivity. Concerned that auto-antibodies didn’t explain all the reactivity seen, an additional two random donors were flow crossmatched using this recipient’s serum and identified similar B-cell reactivity. Ultimately the medical decision was to proceed with transplantation. In conclusion, an autologous flow crossmatch is our first step to evaluate an unexpected positive allogeneic flow crossmatch. As illustrated in our second patient, the results of the autologous flow crossmatch may require further testing to fully explain results and make the best possible transplant decision. We have modified our protocol to perform an upfront autologous flow crossmatch for potential recipients of deceased donor organs. This practice change has decreased turn-around-time and improved communication with surgical colleagues.
P163
HLA TYPING FOR A RARE CASE WITH DISSEMINATED NONTUBERCULOUS MYCOBACTERIAL INFECTIONS Jaishree Patel, Brian Nortan, Christine Braun, Zeying Du. Loyola University Medical Center, Pathology, Maywood, IL, United States. Aim: A newly defined rare clinical syndrome of disseminated non-tuberculous mycobacterial (NTM) diseases in patients with or without other opportunistic infections is seen expandable cases. These patients have been recognized in association with interferon-gamma auto-antibodies patients and as Asian descent. It is not known the pathophysiology of anti-interferon-gamma in the disease. However, human leukocyte antigen (HLA)- DRB1⁄15:01, DRB1⁄16:02, DQB1⁄05:01 and DQB1⁄05:02 are associated with the syndrome in a small cohort study. Here we report a case with 16-year spanning history of disseminated Mycobacterium avium intracellulare (MAI) infections involved lungs, bones, spines and lymph nodes. HLA typing was performed in assisting her diagnosis. Methods: A 73 year old Asian woman was diagnosed in 2000 MAI infection with positive sputum and lung biopsy culture of MIA in an outside hospital. She was treated with antimycobacterial therapy and was back to normal chest X ray. In 2002, she had a persistently elevated WBC and was suspected to have a hematological malignancy because of lymphadenopathy. In 2006, she developed her bone lesions and MIA culture positive in her spine L4 biopsy. She continued antimycobacterial therapy until 2008 due to the drug toxicities. The she had an L3 compression fracture in 2011 and multiple hepatic masses in 2014 and continued these lesions in 2015 and 2016. HLA typing was performed by LabType (One Lambda). Patient interferon-gamma autoantibody were sent to NIH (Result is still pending). Results: Patient HLA typing was HLA-A⁄11, 26; B⁄13, ⁄40 (60); C⁄03 (10), 07; DRB1⁄ 04:06/xx, 16:02/xx; DQB1⁄05:02/xx, 03:02/xx; DQA1⁄01, 03; DPB1⁄05:01, DPA1⁄02:02. This patient is positive for DRB1⁄16:02DQB1⁄05:02 haplotype. Conclusions: The patient’s history and cumulative data are consistent with the phenomenon of adultonset immunodeficiency that has been mostly reported for Asian patients who have neutralizing antiinterferon gamma autoantibodies. Her HLA typing revealed that HLA-DRB1⁄16:02, HLA-DQB1⁄05:02 that fits with a increased risk HLA haplotype. As the increase cases of NTM globally, it is beneficial to have knowledge of HLA association with this disease in HLA laboratories.
155
P162
UNEXPECTED POSITIVE FLOW CROSSMATCH WITH A DECEASED DONOR ORGAN: TIMING OF AUTOLOGOUS FLOW CROSSMATCH? Justin Kreuter, Lisa Hallaway, Laurie Wakefield, Manish Gandhi. Mayo Clinic, Rochester, MN, United States. We describe two recipients of deceased donor organs who had a positive flow crossmatch despite being negative for donor specific antibodies (DSA), as determined by single antigen beads (SAB; LabScreen, One Lambda). The first patient, a 56 year old male, was offered a kidney from a deceased donor. The positive allogeneic flow crossmatch results are shown in Table 1. Interestingly, a recent SAB was negative for DSA. To facilitate clinical interpretation, an autologous flow crossmatch was immediately performed, which demonstrated significant auto-reactivity. Therefore, the positive allogeneic flow crossmatch was interpreted as most likely due to auto-reactive antibodies and the medical decision was to proceed with transplantation. The second patient, a 60 year old female, was offered a kidney from a deceased donor. The positive allogeneic flow crossmatch results are shown in Table 1. A recent SAB was negative for any antibodies greater than mean fluorescence intensity of 300. An autologous flow crossmatch was immediately performed, which demonstrated significant, although somewhat attenuated, auto-reactivity. Concerned that auto-antibodies didn’t explain all the reactivity seen, an additional two random donors were flow crossmatched using this recipient’s serum and identified similar B-cell reactivity. Ultimately the medical decision was to proceed with transplantation. In conclusion, an autologous flow crossmatch is our first step to evaluate an unexpected positive allogeneic flow crossmatch. As illustrated in our second patient, the results of the autologous flow crossmatch may require further testing to fully explain results and make the best possible transplant decision. We have modified our protocol to perform an upfront autologous flow crossmatch for potential recipients of deceased donor organs. This practice change has decreased turn-around-time and improved communication with surgical colleagues.
P163
HLA TYPING FOR A RARE CASE WITH DISSEMINATED NONTUBERCULOUS MYCOBACTERIAL INFECTIONS Jaishree Patel, Brian Nortan, Christine Braun, Zeying Du. Loyola University Medical Center, Pathology, Maywood, IL, United States. Aim: A newly defined rare clinical syndrome of disseminated non-tuberculous mycobacterial (NTM) diseases in patients with or without other opportunistic infections is seen expandable cases. These patients have been recognized in association with interferon-gamma auto-antibodies patients and as Asian descent. It is not known the pathophysiology of anti-interferon-gamma in the disease. However, human leukocyte antigen (HLA)- DRB1⁄15:01, DRB1⁄16:02, DQB1⁄05:01 and DQB1⁄05:02 are associated with the syndrome in a small cohort study. Here we report a case with 16-year spanning history of disseminated Mycobacterium avium intracellulare (MAI) infections involved lungs, bones, spines and lymph nodes. HLA typing was performed in assisting her diagnosis. Methods: A 73 year old Asian woman was diagnosed in 2000 MAI infection with positive sputum and lung biopsy culture of MIA in an outside hospital. She was treated with antimycobacterial therapy and was back to normal chest X ray. In 2002, she had a persistently elevated WBC and was suspected to have a hematological malignancy because of lymphadenopathy. In 2006, she developed her bone lesions and MIA culture positive in her spine L4 biopsy. She continued antimycobacterial therapy until 2008 due to the drug toxicities. The she had an L3 compression fracture in 2011 and multiple hepatic masses in 2014 and continued these lesions in 2015 and 2016. HLA typing was performed by LabType (One Lambda). Patient interferon-gamma autoantibody were sent to NIH (Result is still pending). Results: Patient HLA typing was HLA-A⁄11, 26; B⁄13, ⁄40 (60); C⁄03 (10), 07; DRB1⁄ 04:06/xx, 16:02/xx; DQB1⁄05:02/xx, 03:02/xx; DQA1⁄01, 03; DPB1⁄05:01, DPA1⁄02:02. This patient is positive for DRB1⁄16:02DQB1⁄05:02 haplotype. Conclusions: The patient’s history and cumulative data are consistent with the phenomenon of adultonset immunodeficiency that has been mostly reported for Asian patients who have neutralizing antiinterferon gamma autoantibodies. Her HLA typing revealed that HLA-DRB1⁄16:02, HLA-DQB1⁄05:02 that fits with a increased risk HLA haplotype. As the increase cases of NTM globally, it is beneficial to have knowledge of HLA association with this disease in HLA laboratories.
155