2015-2017 - Advanced Renal Transplantation - Interactive Teaching Series
Role of the Histocompatibility Laboratory in Solid Organ Transplantation circa 2015
1.1 - Role of the Histocompatibility Laboratory in Solid Organ Transplantation circa 2015
Presenter: Howard M., Gebel, Atlanta, GA, USA
Authors: Howard M. Gebel
In 1969, the seminal publication by Patel and Terasaki reported that a positive pretransplant lymphocyte crossmatch between recipient serum and donor lymphocytes was associated with a high risk of hyperacute renal allograft rejection. Subsequent studies demonstrated that the risk of rejection was greatest when positive crossmatches were due to pre-existing donor directed HLA antibodies and particularly when the antibodies were complement fixing. Identification of donor directed antibodies became (and still remains) the highest priority of histocompatibility laboratories. In the nearly fifty years since the pre-transplant crossmatching was implemented, there has been a steady and continuous evolution of methodologies and platforms, from cytotoxicity testing to flow crossmatching, from identification of HLA antigens and antibodies using frozen cell panels to their modern day identification using HLA antigen/nucleotide probe coated microparticles, from simple antibody binding assays to tests that evaluate the function of donor specific antibodies and from physical crossmatching to virtual crossmatching. Due to the increased precision of HLA antibody and antibody identification, deceased donor organs are being allocated to highly sensitized patients more than anytime in the past, and, as a result, these patients are being transplanted at a rate not previously seen. Several recently developed web based tools provide additional support to assess donor:recipient compatibility. The past has brought the field to an exciting present. What does the future hold?
Howard M. Gebel, Ph.D., has been Professor of Pathology and Co-Director of the Histocompatibility and Molecular Immunogenetics Laboratory at Emory University since 2001. He was awarded his Ph.D. in Immunology from the University of Missouri in 1977 and did his post-doctoral fellowship in the Department of Pathology at Washington University Medical Center in St. Louis, MO. In 1979, Dr. Gebel was appointed to the Washington University. faculty and named Associate Director of the Histocompatibility and Clinical Immunology Laboratories at Barnes Hospital. Dr. Gebel relocated to Rush Medical College in Chicago IL in 1984 as Director of the Histocompatibility and Immunogenetics Laboratory and in 1998, was named Director of the Histocompatibility and Transplant Immunology Laboratories at Louisiana State University in Shreveport, LA. Dr. Gebel is an internationally recognized expert in histocompatibility testing and has published extensively during his 35 + year career. He is a senior staff member of the Scientific Registry for Transplant Recipients as an advisor for HLA related issues. He is an editorial board member of the American Journal of Transplantation, Transplant Immunology and Human Immunology and an ad-hoc reviewer for several journals including The New England Journal of Medicine and JAMA. Dr. Gebel is a frequent speaker at local, national and international scientific forums where his presentations focus on the detection, identification and clinical relevance of donor directed HLA alloantibodies.
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