Letter to the Editor

Ann Lab Med 2020; 40(5): 424-427

Published online September 1, 2020

Copyright © Korean Society for Laboratory Medicine.

False Positive Class II HLA Antibody Reaction Due to Antibodies Against Denatured HLA Might Differ Between Assays: One Lambda vs. Immucor

Borae G. Park, M.D., Ph.D.1 , Younhee Park, M.D., Ph.D.2 , Beom Seok Kim, M.D., Ph.D.3 , Yu-Seun Kim, M.D., Ph.D.4 and Hyon-Suk Kim, M.D., Ph.D.2

1Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Korea; Departments of 2Laboratory Medicine, 3Nephrology, and 4Transplant Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Younhee Park, M.D., Ph.D.
Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Tel: +82-2-2228-2440, Fax: +82-2-364-1583, E-mail:

Received: October 6, 2019; Revised: January 3, 2020; Accepted: March 13, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Fig. 1.

Reactivity patterns of class II HLA antibody assays. (A) LABScreen SAB class II (One Lambda, Canoga Park, LA, USA) SABA showing pan-HLA-DR positivity. Self-HLA-DR antigens are indicated by red circles. (B) Lifecodes class II SABA (Immucor, Stamford, CT, USA) showing positivity for HLA-DR51 and -DR9. (C) PRA Identification Bead Reaction (LABScreen PRA, One Lambda) showing weak positivity for HLA-DR51, DR15, and DR16.

Abbreviations: see Table 1.

Assignment of class II HLA antibody specificity according to bead type and manufacturer

Kit usedClass II HLA antibody specificity identified in each essay*Source of antigen
One Lambda SABA (LABScreen SAB)Strong:_DR1, DR4, DR7, DR8, DR9, DR10, DR11, DR12, DR13, DR14, DR15, DR16, DR17, DR18, DR51, DR52, DR52, DR103, DQ2, DQ4, DQ5, DQ6, DQA1*01:01, DQA1*01:02, DQA1*03:01, DQA1*04:01
Moderate: DQ8, DQ9
Weak: DQA1*02:01
Recombinant HLA molecule
Immucor SABA (Lifecodes LSA)Weak: DR51, DR103, DR9Recombinant HLA molecule
One Lambda screening (LABscreen Mixed)Negative for class II HLA antibodiesPurified human HLA
One Lambda identification (LABscreen PRA)Weak: DR15, DR16, DR51Purified human HLA

  1. Lobashevsky AL. Methodological aspects of anti-human leukocyte antigen antibody analysis in solid organ transplantation. World J Transplant 2014;4:153-67.
  2. El-Awar N, Terasaki PI, Nguyen A, Sasaki N, Morales-Buenrostro LE, Saji H, et al. Epitopes of human leukocyte antigen class I antibodies found in sera of normal healthy males and cord blood. Hum Immunol 2009;70:844-53.
  3. Visentin J, Guidicelli G, Bachelet T, Jacquelinet C, Audry B, Nong T, et al. Denatured class I human leukocyte antigen antibodies in sensitized kidney recipients: prevalence, relevance, and impact on organ allocation. Transplantation 2014;98:738-44.
  4. Morales-Buenrostro LE, Terasaki PI, Marino-Vazquez LA, Lee JH, El-Awar N, Alberu J. “Natural” human leukocyte antigen antibodies found in nonalloimmunized healthy males. Transplantation 2008;86:1111-5.
  5. In JW, Rho EY, Shin S, Park KU, Song EY. False-positive reactions against HLA class II molecules detected in Luminex single-antigen bead assays. Ann Lab Med 2014;34:408-10.
  6. Grenzi PC, de Marco R, Silva RZR, Campos EF, Gerbase-DeLima M. Antibodies against denatured HLA class II molecules detected in Luminex-single antigen assay. Hum Immunol 2013;74:1300-3.
  7. Roufosse C, Simmonds N, Groningen MC, Haas M, Henriksen KJ, Horsfield C, et al. A 2018 reference guide to the Banff classification of renal allograft pathology. Transplantation 2018;102:1795-814.
  8. Visentin J, Marroc M, Guidicelli G, Bachelet T, Nong T, Moreau JF, et al. Clinical impact of preformed donor-specific denatured class I HLA antibodies after kidney transplantation. Clin Transplant 2015;29:393-402.
  9. El-Awar N, Lee JH, Tarsitani C, Terasaki PI. HLA class I epitopes: recognition of binding sites by mAbs or eluted alloantibody confirmed with single recombinant antigens. Hum Immunol 2007;68:170-80.