• Klíčová slova
• non HLA protilátky, technologie Luminex,
• MeSH
• autoprotilátky * klasifikace   škodlivé účinky   toxicita   MeSH
• HLA antigeny imunologie   MeSH
• lidé MeSH
• rejekce štěpu diagnóza   etiologie   komplikace   MeSH
• testování histokompatibility metody   MeSH
• transplantace orgánů * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

• MeSH
• diagnostické techniky kardiovaskulární MeSH
• ekonomika a organizace zdravotní péče MeSH
• kachexie etiologie   MeSH
• kardiorenální syndrom etiologie   MeSH
• kontraindikace léčebného výkonu MeSH
• lidé MeSH
• podpůrné srdeční systémy MeSH
• progrese nemoci * MeSH
• remodelace komor MeSH
• selhání jater etiologie   MeSH
• srdeční selhání * komplikace   MeSH
• testování histokompatibility metody   MeSH
• transplantace srdce metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Protilátkami zprostředkovaná (humorální) rejekce je závažná komplikace, která je asociována se zhoršenou prognózou přežití transplantovaných orgánů. Její diagnostika byla dlouho zaměřena na detekci protilátek specifických proti HLA antigenům, nicméně se v posledních letech ukázalo, že při rozvoji této rejekce mohou hrát roli i protilátky proti antigenům, které jsou kódovány geny mimo HLA komplex. Non HLA antigeny jsou polymorfní molekuly, a proto mohou být rozpoznány imunitním systémem příjemců orgánů. Tyto antigeny se vyskytují na povrchu endoteliálních a epiteliálních buněk, ale mohou být lokalizovány i intracelulárně a uvolňovat se v případě buněčné lýze. Mezi non HLA antigeny patří molekuly MICA – major-histocompatibility-complex (MHC) class I-related chain A, receptor angiotensinu II-R1, kolagen, K-α1 tubulin, srdeční myosin, vimentin a další. Non HLA protilátky se mohou vyskytovat před transplantací, ale rovněž mohou být produkovány i de novo. Diagnostika non HLA protilátek se provádí za využití xMap technologie (Luminex) nebo endoteliálním crossmatch (křížová zkouška) a dalšími technikami. Nicméně všechny metodiky i interpretace výsledků non HLA má svá úskalí.

Antibody-mediated (humoral) rejection (AMR) is a serious complication that is associated with a worse prognosis of survival of transplanted organs. The diagnosis of AMR has been long time focused on the detection of antibodies specific to HLA antigens, however, in recent years it has become clear that antibodies against antigens encoded by genes outside the HLA complex can also play a role in the development of AMR. Non-HLA antigens are polymorphic molecules and therefore can be recognised by the immune system of organ transplant recipients. These antigens are expressed on the surface of endothelial and epithelial cells, but can also be localised intracellularly and released in case of cell lysis. Non-HLA antigens include molecules MICA – major-histocompatibility-complex (MHC) class I-related chain A, angiotensin II-R1 receptor (ATR1), collagen, K-α1 tubulin, cardiac myosin, vimentin and others. Non-HLA antibodies can occur before transplantation, but may also be produced de novo. The diagnosis of non-HLA antibodies is carried out using xMap technology (Luminex), the so-called endothelial crossmatch and other techniques, however, all methodologies and interpretation of results have their pitfalls.

• Klíčová slova
• non HLA protilátky, technologie Luminex,
• MeSH
• autoprotilátky klasifikace   škodlivé účinky   toxicita   MeSH
• HLA antigeny * imunologie   MeSH
• lidé MeSH
• rejekce štěpu diagnóza   etiologie   komplikace   MeSH
• testování histokompatibility metody   MeSH
• transplantace orgánů MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

• MeSH
• darování krve dějiny   MeSH
• konzervace krve dějiny   MeSH
• krev * MeSH
• krevní transfuze dějiny   MeSH
• lidé MeSH
• určování krevní skupiny a křížové zkoušky dějiny   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• historické články MeSH

The guidelines for the implementation and reporting of HLA nomenclature for the World Marrow Donor Association have served as a reliable standard for communication of HLA data in the hematopoietic cell transplantation process. Wider use of next-generation sequencing made a special provision of the guidelines increasingly pertinent: how to communicate novel HLA alleles. Novel alleles need to be recognized by the WHO Nomenclature Committee for Factors of the HLA system to obtain official allele designations. Until then they have to be handled according to the specific rules. Leaving the actual rules basically unchanged we give some advice on how to communicate novel alleles to best facilitate the search process for cases where novel alleles are identified on donor or patient side.

• MeSH
• alely MeSH
• HLA antigeny genetika   MeSH
• kostní dřeň * MeSH
• lidé MeSH
• testování histokompatibility MeSH
• transplantace hematopoetických kmenových buněk * MeSH
• vysoce účinné nukleotidové sekvenování MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

HLA-A*29:172 allele differs from HLA-A*29:01:01:01 by one missense single C/G nucleotide exchange in codon 77.

• MeSH
• alely MeSH
• exony genetika   MeSH
• exprese genu MeSH
• jednonukleotidový polymorfismus * MeSH
• lidé MeSH
• sekvence nukleotidů MeSH
• sekvenční analýza DNA MeSH
• sekvenční seřazení MeSH
• testování histokompatibility MeSH
• transplantace hematopoetických kmenových buněk * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Complete and high-resolution (HR) HLA typing improves the accurate assessment of donor-recipient compatibility and pre-transplant donor-specific antibodies (DSA). However, the value of this information to identify de novo immune-mediated graft events and its impact on outcomes has not been assessed. In 241 donor/recipient kidney transplant pairs, DNA samples were re-evaluated for six-locus (A/B/C/DRB1/DQB1+A1/DPB1) HR HLA typing. De novo anti-HLA antibodies were assessed using solid-phase assays, and dnDSA were classified either (1) as per current clinical practice according to three-locus (A/B/DRB1) low-resolution (LR) typing, estimating donor HLA-C/DQ typing with frequency tables, or (2) according to complete six-locus HR typing. The impact on graft outcomes was compared between groups. According to LR HLA typing, 36 (15%) patients developed dnDSA (LR_dnDSA+). Twenty-nine out of 36 (80%) were confirmed to have dnDSA by HR typing (LR_dnDSA+/HR_dnDSA+), whereas 7 (20%) did not (LR_dnDSA+/HR_dnDSA-). Out of 49 LR_dnDSA specificities, 34 (69%) were confirmed by HR typing whereas 15 (31%) LR specificities were not confirmed. LR_dnDSA+/HR_dnDSA+ patients were at higher risk of ABMR as compared to dnDSA- and LR_dnDSA+/HR_dnDSA- (logRank < 0.001), and higher risk of death-censored graft loss (logRank = 0.001). Both LR_dnDSA+ (HR: 3.51, 95% CI = 1.25-9.85) and LR_dnDSA+/HR_dnDSA+ (HR: 4.09, 95% CI = 1.45-11.54), but not LR_dnDSA+/HR_dnDSA- independently predicted graft loss. The implementation of HR HLA typing improves the characterization of biologically relevant de novo anti-HLA DSA and discriminates patients with poorer graft outcomes.

• MeSH
• HLA antigeny * genetika   MeSH
• HLA-C antigeny MeSH
• lidé MeSH
• přežívání štěpu MeSH
• rejekce štěpu * diagnóza   MeSH
• testování histokompatibility MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE: Various strategies are utilised to reduce blood loss and allogenic blood transfusion for posterior instrumented correction of Adolescent Idiopathic Scoliosis (AIS). The aim of this study was to evaluate post-operative blood transfusion requirements to determine whether routine cross matching of blood is essential. METHODS: This is a prospective case series of 84 patients who underwent posterior correction of AIS between September 2016 and March 2018. We reviewed demographic, operative, radiological data and transfusion requirements. Results of transfusion requirements in 44 patients who underwent Ponte osteotomies (F:M = 36:8; mean age 14.8 years) were compared with 40 patients (F:M = 9:31; mean age 14.4 years) who did not and provided the control group. A transfusion trigger of 80 mg/dl with clinical caveats was utilised. Cross matching and procurement costs of allogenic blood/unit were ascertained. RESULTS: Five patients required postoperative blood transfusion on days 2 or 3. Anaesthetic time (p = 0.0003) and preoperative Cobb angle (p = 0.0166) were significant variables between both groups and post-operative Hb (p = 0.0084) and number of levels fused (p = 0.0312) being significant in patients requiring transfusion. Unutilised units on the day of the operation incurred £30,030 (£380/patient or £154/unit) in operational costs. CONCLUSION: Our audit demonstrates that transfusion on the day of the operation was not required. We recommend that routine crossmatching is not essential for primary posterior correction for AIS with blood conservation techniques. Blood grouping with availability of urgent blood is sufficient at the onset of operation. This has financial implications and cost savings. LEVELS OF EVIDENCE: III.

• MeSH
• krevní transfuze metody   MeSH
• krvácení při operaci prevence a kontrola   MeSH
• kyfóza * MeSH
• lidé MeSH
• mladiství MeSH
• retrospektivní studie MeSH
• skolióza * chirurgie   MeSH
• určování krevní skupiny a křížové zkoušky MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH

This book contains informations about HLA antigenes and histocompatibility testing. Intended for proffesional public.

• MeSH
• HLA antigeny MeSH
• testování histokompatibility MeSH
• Publikační typ
• monografie MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• alergologie a imunologie

Immunisation against Human Leucocyte Antigens (HLA) can be caused by pregnancy, blood transfusion, or organ transplants. The HLA antibody status of a given patient significantly influences their access and waiting time to transplant. For some highly sensitised patients (HSP) there is hardly any suitable donor available in the deceased donor pool of their allocation organisation and therefore they wait a very long time before being offered a kidney for transplant. Especially patients with rare HLA phenotypes in relation to the actual donor pool are waiting extremely long. As HLA phenotypes are different in the various European populations, we hypothesized that extension of the donor pool outside the respective allocation system will increase the chance of receiving a compatible transplant for this subgroup of highly sensitised patients. One of the objectives of the EUROSTAM project, (a Europe-wide Strategy to enhance Transplantation of highly sensitised patients on the basis of Acceptable HLA Mismatches) was to develop a tool to compare the chance of transplanting HSP in different European populations with donor organs from within and outside their own donor pool. Information on the HLA type and ABO blood group of the actual donor population, as well as the acceptable mismatches of long waiting HSP were obtained from the EUROSTAM partner organizations i.e. Eurotransplant (ET), UK National Health Service Blood and Transplant (NHSBT), Barcelona, Prague and Athens. Results from simulations using the newly developed tool shows that 195 (27%) of the 724 long waiting highly sensitised patients registered at each partner organisation have increased chances of transplant in a different European donor pool. This makes a strong case for sharing kidneys between European countries for selected difficult to transplant patients.

• MeSH
• dárci tkání MeSH
• histokompatibilita MeSH
• HLA antigeny genetika   imunologie   MeSH
• imunizace MeSH
• lidé MeSH
• příjemce transplantátu MeSH
• seznamy čekatelů MeSH
• testování histokompatibility metody   MeSH
• transplantace ledvin * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• úvodníky MeSH
• Geografické názvy
• Evropa MeSH