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Impressum
Immunogenetics in the beginning of the new century
Doxiadis I. N.
Department of Immunohematology & Blood Bank, University Medical Center, Leiden
Background: During the past 40 years typing for the human leukocyte
antigens (HLA) was done using serological techniques. The respective reagents
were sera obtained from multiparous women or patients. Several improvements
were achieved with respect to the efficiency and reliability of the techniques
used. However, one of the major drawbacks of serology is the need of viable
cells. While this point did not cause problems for healthy individuals,
peripheral blood cells from patients and prospective organ and tissue
donors have often a lower viability and also sometimes a lower expression
of the respective antigens on the cell surface. This makes serological
typing difficult. In the mid eighties molecular typing was introduced
in many laboratories. The first period of molecular typing dealt with
the so-called restriction fragment length polymorphism method. This time
consuming and rather tedious technique was not suitable for prospective
typing but was used for retrospective analyses for example on the importance
of HLA-matching in organ transplantation. Later, through the introduction
of the polymerase chain reaction the suitability of molecular techniques
with respect to prospective typing was achieved.
Methods: International workshops and the effort of many laboratories
lead to a standardization of the methods. External Proficiency Testing
Exercises on transplantation relevant procedures in the laboratories affiliated
to transplantation centers and the introduction of an accreditation system
in the USA and in Europe increased significantly the reliability of all
relevant immunogenetical testings.
Results: To date, patients, prospective organ and tissue donors
are typed in addition to serology also with molecular methods. Using these
techniques the reliability and reproducibility of HLA typing reached levels
of >98%. Even 8 days old peripheral blood samples can be now typed
routinely with these methods, something impossible by serology. Besides
the improvement in the typing also improvement was observed for all transplantation
relevant immunogenetical methods and applications.
Conclusion: The laboratories affiliated to the transplantation
centers are ready for the challenge of the new century.