Evaluation of three different laboratory methods to detect preformed human leukocyte antigen antibodies in a South African kidney transplant population

Afr Health Sci. 2021 Jun;21(2):735-742 doi: 10.4314/ahs.v21i2.32.

Anti-human leukocyte antigen antibodies (anti-HLA) play a crucial role in graft. Detection of anti-HLA, both pre- and post-transplant is a crucial investigation in clinical organ transplantation.


Three methodologies for the detection of lymphocytotoxic antibodies were compared to establish which of these is best suited to optimise pre-transplant donor-recipient matching.


Serum samples from 15 renal transplant patients were tested for the presence of anti-HLA by i) cytotoxic-dependent cross-match (CDCXM), ii) flow cytometric cross-match (FCXM) and iii) Luminex-based donor specific antibody cross-match (DSAXM) method, Confirmatory tests for the presence of preformed HLA antibodies were tested using Luminex methodology.


Two (13%) of the 15 patients had positive HLA Class I antibodies (Ab) using all 3 methods. An additional 2 HLA Class I Ab were identified with FCXM/CDCXM. DSAXM identified 1 HLA Class I positive, not indicated by CDCXM/FCXM.High HLA Class II positivity (40%), identified by CDCXM, while DSAXM and FCXM identified two and one patients, respectively. CDCXM produced 4 false-positive results confirmed by lymphocyte single antigen (LSA) assay.


The DSAXM method appears to add value in pre-transplantation screening to identify pre-sensitised patients that may not reject the donor graft due to the absence of donor-specific antibodies.

LEVEL OF EVIDENCE: Case Series / Case Control / Cohort
KEYWORDS: Preformed human leukocyte; South Africa; antigen antibodies; kidney transplant; population
MESH HEADINGS: Adult; Antilymphocyte Serum; Clinical Laboratory Techniques; Female; HLA Antigens; Humans; Kidney Transplantation; Male; Middle Aged; South Africa; Young Adult