1. Terasaki Festschrift 2014 Clinical Relevance of Pre- and Post-Transplant HLA antibodies, Donor-Specific and Non-Donor-Specific HLA Antibodies Detected by ELISA in Renal Transplantation Po-Chang Lee, M.D.,M.T.L. Professor of Surgery National Cheng Kung University Hospital, Taiwan Chairperson of the Board Taiwan Organ Registry and Sharing Center

3. De novo Post-Transplant Antibody 0<6M1yr2345678yr Lee PC, Terasaki PI, et al. Transplantation 2002; 74(8): 1192-1194

4. 2. Dangerous Late F ailure Early Lee, PC, Terasaki, et al, Early antibodies Transplantation 2009;88:568-574

5. HLA Abs detected method and cost ELISA LATM (Screening): US12 LAT (Identification): US60 Luminex LAB (single antigen bead assay): US 558

6. Table 1. Patient characteristics HLA- (n= 162)HLA+ (n= 18)P-Value Age (years)40.9±13.0 45.7±10.6 0.134 Sex (Male)77 (48%)13 (72%)0.047* Source (Living)75 (46%)11 (61%)0.233 Donor Blood type A54 (33%)6 (33%)0.988 B41 (25%)4 (22%) O52 (32%)6 (33%) AB15 (9%)2 (11%) Receiver Blood type A46 (28%)5 (28%)0.952 B35 (22%)4 (22%) O69 (43%)7 (39%) AB12 (32%)2 (11%) CDC XM154 (95%)15 (83%)<0.001* DTT CDC XM8 (5%)3 (17%) HBV (+)19 (12%)1 (6%)0.698 HCV (+)18 (11%)2 (11%)1.000 Patient survival follow up33.2±21.518.9±13.3<0.001* Graft survival follow up31.9±21.518.8±13.30.001*

7. Figure 1. Pre- Transplant HLA Antibodies being Detected

8. DSA vs NDSA vs HLA Ab( － )DSA vs HLA Ab( － )NDSA vs HLA Ab( － ) OD=2P=0.111 (N=6 vs 12 vs 162)0.2080.065* OD=4 P=0.015* (N=5 vs 13 vs 162)0.6150.0005* OD=6P=0.032* (N=3 vs 15 vs 162)0.6770.010* OD=8P=0.093 (N=1 vs 17 vs 162)0.8510.029* Table 2. Comparison of Graft Survival According to Pre-transplant HLA Antibodies, DSA and NDSA being Detected

9. Figure 2. Post-transplant HLA Antibodies being Detected

10. DSA vs NDSA vs HLA Ab( － )DSA vs HLA Ab( － )NDSA vs HLA Ab( － ) OD=2P=0.064 (N=13 vs 19 vs 148)0.047*0.290 OD=4P=0.186 (N=9 vs 23 vs 148)0.0840.717 OD=6P=0.015 (N=4 vs 28 vs 148)0.006*0.599 OD=8P=0.912 (N=1 vs 31 vs 148)0.1240.895 Table 3. Comparison of Graft Survival According to Post-transplant HLA Antibodies, DSA and NDSA being Detected

11. Figure 3. Post-transplant HLA Antibodies to Class I or Class II being Detected

12. Pre- / Post- transplant3 years GS5 years GSP-Value ＋ / ＋ (N=14) vs ＋ / － (N=4) 65.6% vs 100% 0.362 ＋ / ＋ (N=14) vs － / ＋ (N=18) 65.6% vs 100% 0.043* ＋ / ＋ (N=14) vs － / － (N=144) 65.6% vs 92.0%65.6% vs 85.5%0.015* ＋ / － (N=4) vs － / ＋ (N=18) 100% vs 100% 1.0 ＋ / － (N=4) vs － / － (N=144) 100% vs 92.0%100% vs 85.5%0.656 － / ＋ (N=18) vs － / － (N=144) 100% vs 92.0%100% vs 85.5%0.966 Table 4. Comparison of Graft Survival According to Pre-transplant and Post-transplant HLA Antibodies being Detected

13. Figure 4. Comparison of Graft Survival According to Pre- transplant CDC-XM and DTT CDC-XM

14. Take Home Message 1.There was a significant difference in graft survival between patients with pre-transplant NDSA and those without HLA antibodies (P=0.0005). 2. There was a significant difference in graft survival between patients with post-transplant DSA and those without HLA antibodies (P=0.006). 3. For patients who had persistent pre- and post- transplant HLA antibodies, worst long term survival could be found. 4, We believe HLA antibody analysis by ELISA is still very useful for transplantation.

15. National Cheng Kung University Hospital, Tainan, Taiwan

16. Q & A