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Master Thesis

Étude de l’évolution du profil d’immunisation des patients hyper immunisés en attente de transplantation rénale

Abstract : Anti-HLA highly sensitized (HS) patients awaiting kidney transplantation benefit from national priority through the “HAP” program (HS with acceptable antigens). Maintaining this priority requires these patients have a serum tested with Single Antigen Flow Beads (SAFB) assays every 105 days in order to detect potential anti-HLA antibodies emergence and then prevent unexpected positive crossmatches. However, it seems that there is an imbalance between this high surveillance rate and the apparent stability of patient sensitization profiles. We aimed to assess the relevance of the quarterly biological follow-up of HS patients. We included 166 HS patients displaying at least 2 sera tested at 3-month intervals during their waiting period (S, the most recent, and S-3M). A median of 3 sera per patient were tested with SAFB. We also retrieved the occurrence of allogeneic and non-allogeneic immunological events for 75 patients. From the 357 serum pairs studied, only 0.7% of class I beads and 0.5% of class II beads crossed the unacceptable antigen threshold at the S serum [mean fluorescence intensity (MFI)≥2000] with a median MFI of 2963 and 2607, respectively. These beads corresponded to 248 antigens. Among them, 90% were above the threshold of the acceptable antigens (500< MFI< 2000) at S-3M. The mean increase of calculated panel reactive antibodies was 2%. Variations in HS patient profiles were not related to patient history of allogeneic events but depended on the occurrence of non-allogeneic events such as vaccines, inflammatory states and even more of allogeneic events such as immunosuppression withdrawal/transplantectomy, transfusion or pregnancy. Changes in HS patient anti-HLA profiles are marginal within 3-months periods and had a limited immunological impact. Most of them are related to the occurrence of immunological events. Therefore, the monitoring of these HS patients could be optimized towards a dynamic monitoring rather than a systematic quarterly monitoring.
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Submitted on : Wednesday, October 21, 2020 - 12:13:28 PM
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Élodie Wojciechowski. Étude de l’évolution du profil d’immunisation des patients hyper immunisés en attente de transplantation rénale. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02973829⟩

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